{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER   A MADSION","gend":1,"add":"109 KELSEY ROAD","city":"FREDERICKBURG","state":"VA","zip":"22554-7011","dob":"1979-10-10","age":"","mstatus":"","insh":4294979,"cliId":"","pno":5407555005,"cno":5407555005,"email":"","ename":"","eno":"","pphy":"ANBESSIE, TEDLA B","ppno":5406579191,"pcpadd":"2146 Jefferson Davis Hwy, Ste 101","pcpcity":"Stafford","pcpstate":"VA","pcpzip":225547223,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"109 KELSEY ROAD","madd2":"                                                            ","madd3":"","mcity":"FREDERICKBURG","mstate":"VA","mzip":"22554-7011","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J01.00","H66.91","J02.9","J20.9","R06.2","F41.9","R07.89","E86.0","F10.120","R07.9","K27.9","R00.0","K52.9","J33.9","R10.9","R11.2","R19.7","S83.411A","W01.0XXA","Y92.89","Y93.89","S89.91XA","N13.2","J45.909","Z86.010","I42.9","K50.90","K21.9","B18.2","Z86.19","F17.210","Z88.6","Z88.1","Z79.51","J32.9","R10.13","M25.561","Z72.0","K51.90","K51.919","K25.3","N20.0","R03.0","N18.9","Z87.09","Z53.29","J01.90","N83.8","Z87.442","Z87.19","Z88.0","Z88.8","R04.2","R06.02","Z87.891","R10.84","K92.1","K63.89","K04.7","L02.411","I43","J45.901","S86.911A","V00.181A","K62.5","N20.2","Z87.01","Z80.0","Z91.013","Y90.8","F11.11","F10.129","Z90.721","Z98.51","Z97.3","Z88.5","S89.92XA","J02.8","X50.1XXA","Y93.01","M19.90","I25.10","E87.6","K25.9","K21.0"],"date":["2020-11-11","2019-02-05","2020-01-08","2019-09-13","2019-09-13","2020-02-05","2020-10-29","2019-02-07","2019-02-07","2020-10-29","2019-02-07","2019-02-07","2020-02-04","2019-11-05","2020-03-21","2019-11-05","2019-11-05","2020-01-30","2020-01-30","2020-01-30","2020-01-30","2020-01-30","2020-03-21","2020-03-21","2019-11-25","2020-10-29","2020-02-04","2020-03-21","2020-10-29","2020-03-21","2020-10-29","2020-03-21","2020-03-21","2020-03-21","2019-11-25","2019-11-25","2020-01-30","2020-02-04","2020-02-07","2020-02-27","2020-02-27","2020-03-21","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2021-02-24","2020-03-21","2020-03-21","2019-11-25","2020-03-21","2020-03-21","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2021-03-03","2019-02-21","2019-02-21","2019-02-21","2019-12-08","2019-12-08","2020-02-03","2020-03-21","2020-03-21","2020-03-21","2020-03-21","2019-02-07","2019-02-07","2019-02-07","2019-02-07","2019-02-07","2019-11-05","2019-11-05","2019-12-08","2020-01-08","2020-01-30","2020-01-30","2020-01-30","2019-02-08","2020-02-05","2020-02-05","2020-02-05"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","65162052111","PROMETHAZINE ","TAB 25MG","30","Select","Select",""],["","00093227534","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00591079401","DICYCLOMINE ","CAP 10MG","60","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E HFA INH","8.5","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","00185041552","BUPROPION ","TAB 150MG SR","60","Select","Select",""],["","00054001829","PREDNISONE ","TAB 20MG","18","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","00406051201","OXYCOD\/APAP ","TAB 5-325MG","20","Select","Select",""],["","53746027205","SMZ\/TMP ","TAB 800-160","10","Select","Select",""],["","67405065155","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","65862056090","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","15","Select","Select",""],["","65162006205","SUCRALFATE ","SUS 1GM\/10ML","560","Select","Select",""],["","69315090505","LORAZEPAM ","TAB 1MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","15","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0.5","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}