{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTINA   M SIMMONS","gend":1,"add":"15344 LONE PINE DRIVE","city":"TIMBERVILLE","state":"VA","zip":"22853-2732","dob":"2000-07-27","age":"","mstatus":"","insh":4310703,"cliId":"","pno":5408106985,"cno":5408106925,"email":"","ename":"","eno":"","pphy":"BRECH, KILIAN H","ppno":5403449213,"pcpadd":"21 Highland Ave SE, Ste 100","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240132218,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":5408106925,"add2":"                                                            ","add3":"","madd1":"388 Rayann Ln","madd2":"                                                            ","madd3":"","mcity":"Broadway","mstate":"VA","mzip":"22815-9576","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O21.0","Z3A.17","Z32.01","O99.89","R10.2","Z3A.01","Z88.0","Z91.018","Z87.891","O36.8320","O9A.212","S39.91XA","W22.8XXA","Y92.009","O99.891","M54.9","N85.8","Z3A.26","Z3A.25","M54.41","M54.17","R29.898","R29.6","M41.9","M54.42","G89.29","O21.9","O99.281","E86.0","Z3A.11","R51","R22.0","R11.2","O20.9","O36.80X0","O02.1","R10.13","W01.0XXA","O26.892","O26.841","Z34.01","O46.92","Z3A.24","Z13.0","Z13.1","O26.893","N89.8","Z3A.37","L30.9","Z34.90","Z3A.10","R25.2","Z3A.30","Z79.899","O42.02","O70.0","Z37.0","F20.9","O99.341","O23.42","Z36.89","Z3A.20","Z3A.34","O60.03","O36.5930","Z3A.38","Z34.81","O26.891","Z3A.09","Z11.3","O9A.211","Y04.2XXA","S30.1XXA","R52","W19.XXXA","O23.40","R11.10","Z3A.00","O26.10","Z3A.28","O36.8130","O42.90","Z3A.36","R19.7","O21.8","O20.8","O20.0","R10.9","S31.609A","N93.9","R42","Y04.8XXA","Z74.3","N30.00","R05","J02.9","R14.0","J06.9","W54.1XXA","S39.81XA","Z34.00","R10.31","K59.00","O9A.213","Z04.1","V89.2XXA","Z34.93","Z03.71","O80","T14.8XXA","Z3A.19","Z36.2","Z3A.23","Z3A.33","M51.17","N39.0","B96.89","O69.81X0","R10.84","O42.92","G97.41","O99.892","O9A.22","O89.4","O74.6","Z20.822","L29.8","T36.8X5A"],"date":["2020-07-10","2019-05-05","2020-06-01","2020-06-19","2020-12-30","2020-06-19","2021-01-19","2020-11-29","2021-01-19","2020-10-29","2020-10-30","2020-10-29","2020-10-29","2020-10-29","2020-12-30","2020-10-29","2020-11-29","2020-11-05","2020-10-29","2021-05-18","2021-05-18","2021-04-29","2021-04-29","2021-05-18","2021-05-18","2021-05-18","2019-05-05","2019-03-28","2019-03-28","2020-07-18","2020-03-11","2020-03-11","2020-03-11","2020-03-13","2020-07-15","2020-03-24","2020-07-10","2020-10-30","2020-10-30","2019-03-06","2019-03-18","2019-06-25","2019-06-25","2020-11-24","2020-11-24","2019-09-26","2019-09-26","2021-01-20","2020-06-18","2020-06-19","2020-07-15","2020-11-05","2020-11-29","2021-01-19","2021-01-20","2021-01-20","2021-01-20","2019-03-28","2019-03-28","2019-05-28","2020-09-17","2019-05-28","2020-12-30","2019-09-08","2019-10-03","2019-10-03","2020-07-07","2020-07-10","2020-07-10","2020-07-15","2020-07-18","2020-07-18","2020-07-18","2020-10-29","2020-10-29","2019-02-18","2019-02-18","2020-04-13","2019-07-24","2019-07-24","2020-12-30","2019-09-16","2019-09-16","2020-03-11","2020-03-11","2020-04-13","2020-07-10","2020-12-30","2019-08-09","2020-05-06","2020-04-13","2020-07-18","2020-07-18","2019-01-06","2019-01-06","2019-01-06","2019-01-06","2019-01-06","2019-03-13","2019-03-13","2019-04-09","2019-05-05","2019-05-05","2019-08-09","2019-08-09","2019-08-09","2019-08-09","2019-09-26","2019-10-03","2020-05-06","2020-09-17","2020-10-15","2020-10-15","2020-12-23","2021-05-18","2019-02-18","2019-02-18","2019-10-03","2020-07-18","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-01-19"],"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":[["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00406048410","APAP\/CODEINE ","TAB 300-30MG","16","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","15","Select","Select",""],["","68645056259","IBUPROFEN ","TAB 600MG","24","Select","Select",""],["","10702000709","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","16571020210","DICLOFENAC ","TAB 50MG DR","60","Select","Select",""],["","68382004001","PROMETHAZINE ","TAB 12.5MG","20","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","30","Select","Select",""],["","16714043901","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","21922001704","CLOBETASOL ","OIN 0.0005","30","Select","Select",""],["","00093598627","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","30","Select","Select",""],["","43386016106","MISOPROSTOL ","TAB 200MCG","4","Select","Select",""],["","00591299239","PHENADOZ ","SUP 25MG","30","Select","Select",""],["","55111014512","FLUCONAZOLE ","150MG","2","Select","Select",""],["","52565012230","LIDOCAINE ","4%","121","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","",""],["No","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":""}]}]}