{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN WEATHERBY","gend":0,"add":"13925 LAST LINE LANE","city":"FREDERICKSBURG","state":"VA","zip":"22407-1976","dob":"1977-02-09","age":"","mstatus":"","insh":4357179,"cliId":"","pno":5407295136,"cno":5407295136,"email":"","ename":"","eno":"","pphy":"GOODLETT, ALLISON H","ppno":5407866669,"pcpadd":"4701 Spotsylvania Pkwy Ste 200, ","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224079435,"pcpcounty":"","pcpid":"","pcpname":"SENTARA PRATT MEDICAL GROUP","ano":"","add2":"APT 106","add3":"","madd1":"13925 LAST LINE LANE","madd2":"APT 106","madd3":"","mcity":"FREDERICKSBURG","mstate":"VA","mzip":"22407-1976","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.671","F10.239","R45.851","F17.200","G89.4","I10","K21.9","B19.20","E11.65","E07.89","E78.5","F11.10","F14.10","F32.9","Z79.899","Z81.1","F33.2","F31.9","R73.02","R10.13","R10.9","E11.9","F17.210","R10.11","R11.10","R19.7","Z86.19","L03.113","L03.114","F33.1","F19.10","F11.20","F10.20","F10.229","Z79.84","Z80.8","F11.90","F10.99","R74.0","R56.9","M10.9","M19.071","R76.8","R10.32","R30.0","F43.21","E11.40","F10.10","F41.9","R45.1","Z76.5","M19.90","M79.631","M79.10","B18.2","F10.129","F19.94","F39","E78.1","R11.2","R50.9","Z23","Z53.29","E80.7","R00.0","R68.89","F51.01","Z13.89"],"date":["2019-04-28","2019-05-13","2021-05-06","2020-10-10","2019-05-13","2019-05-14","2019-05-14","2021-05-06","2020-10-06","2019-05-09","2019-05-13","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2019-05-09","2019-05-10","2019-06-07","2019-05-14","2019-08-09","2020-02-19","2020-10-10","2021-05-06","2020-02-19","2020-02-19","2020-02-19","2020-02-19","2020-10-10","2020-10-06","2021-05-14","2021-05-14","2019-05-13","2019-05-13","2019-05-05","2019-05-05","2019-05-05","2019-05-16","2019-05-16","2019-05-12","2021-05-06","2019-04-28","2019-04-28","2019-07-09","2020-02-19","2019-07-09","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2019-04-28","2020-10-10","2020-10-10","2020-10-10","2019-05-10","2019-05-12","2019-05-16","2019-05-13","2020-02-19","2020-02-19","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2019-05-05","2019-06-07","2019-06-07"],"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":[["","67877022305","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","00115681110","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","00143980350","DOXYCYCL ","CAP 100MG","30","Select","Select",""],["","31722053712","LEVETIRACETA ","TAB 500MG","28","Select","Select",""],["","67877056305","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","00088222033","LANTUS ","INJ 100\/ML","10","Select","Select",""],["","67877024601","QUETIAPINE ","TAB 200MG","30","Select","Select",""],["","57664039588","VENLAFAXINE ","TAB 75MG","30","Select","Select",""],["","00093078701","ATENOLOL ","TAB 25MG","30","Select","Select",""],["","51991029301","OXCARBAZEPIN ","TAB 300MG","60","Select","Select",""],["","43547028810","BUPROPION ","TAB 100MG SR","30","Select","Select",""],["","49281063115","FLUZONE ","INJ 2019-20","0.5","Select","Select",""],["","23155007001","METHIMAZOLE ","TAB 5MG","30","Select","Select",""],["","68382080505","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","13668000805","ZOLPIDEM ","TAB 10MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","08290328468","INSULIN ","MIS 0.5\/31G","30","Select","Select",""],["","68462030201","INDOMETHACIN ","CAP 50MG","42","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}