{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CANDICE WALLER","gend":1,"add":"114 DEBBIE LN.","city":"DANVILLE","state":"VA","zip":"24540-1006","dob":"1984-03-30","age":"","mstatus":"","insh":4487621,"cliId":"","pno":4347096923,"cno":4347096923,"email":"","ename":"","eno":"","pphy":"STEPHENS, AMBER","ppno":4347925964,"pcpadd":"2767 Franklin Tpke, ","pcpcity":"Danville","pcpstate":"VA","pcpzip":245405273,"pcpcounty":"","pcpid":"","pcpname":"SOVAH SURGICAL SPECIALISTS","ano":"","add2":"APARTMENT N-97","add3":"","madd1":"114 DEBBIE LN.","madd2":"APARTMENT N-97","madd3":"","mcity":"DANVILLE","mstate":"VA","mzip":"24540-1006","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.21","I16.1","R06.02","I11.0","I50.33","G62.9","G47.30","Z88.8","Z91.040","L03.116","A41.9","E11.9","E78.00","J45.909","I50.9","I42.9","E11.65","E78.5","F41.9","E87.6","E11.42","F32.9","G47.33","D50.9","E11.628","L97.528","I50.22","L03.032","E11.621","N17.9","I16.0","E11.40","Z79.84","Z90.49","I11.9","J96.01","J44.1","Z77.22","R07.89","Z09","L02.91","I10","L02.212","L03.311","E66.9","Z91.09","Z98.890","I50.23","J20.9","R07.9","R79.89","R60.0","O90.3","Z91.048","L02.211","R42","Z87.891","I42.0","E78.2","R05","E87.70","Z76.0","Z72.0","R22.40","Z91.19","Z53.20","Z79.899"],"date":["2019-11-03","2019-01-30","2019-11-03","2019-10-03","2019-03-24","2019-03-24","2019-10-03","2019-11-03","2019-11-03","2019-08-10","2019-08-10","2019-11-03","2019-11-03","2019-11-03","2019-11-03","2019-05-17","2019-08-07","2019-10-03","2019-01-29","2019-01-29","2019-01-29","2019-08-05","2019-01-29","2019-01-29","2019-08-07","2019-08-07","2019-08-07","2019-08-08","2019-08-07","2019-08-07","2019-08-07","2019-08-05","2019-10-03","2019-08-05","2019-10-31","2019-01-05","2019-01-05","2019-01-05","2019-02-05","2019-02-05","2019-02-05","2019-10-31","2019-06-16","2019-06-16","2019-06-16","2019-06-16","2019-06-16","2019-10-03","2019-10-03","2019-11-03","2019-05-17","2019-05-17","2019-05-17","2019-10-31","2019-06-16","2019-10-31","2019-10-31","2019-01-30","2019-01-30","2019-10-03","2019-04-22","2019-04-22","2019-04-22","2019-05-16","2019-05-16","2019-05-16","2019-10-03"],"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":[["","00193725201","CONTOUR ","KIT NEXT EZ","1","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","64980030301","CHLORTHALID ","TAB 25MG","15","Select","Select",""],["","65162010250","GABAPENTIN ","CAP 300MG","30","Select","Select",""],["","53489014305","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","65862018501","CLINDAMYCIN ","CAP 150MG","40","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","60","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","00228202796","ALPRAZOLAM ","TAB 0.25MG","8","Select","Select",""],["","31722052101","HYDRALAZINE ","TAB 50MG","90","Select","Select",""],["","50111091701","TORSEMIDE ","TAB 20MG","60","Select","Select",""],["","00054429731","FUROSEMIDE ","TAB 20MG","3","Select","Select",""],["","00093729605","CARVEDILOL ","TAB 25MG","60","Select","Select",""],["","00054001925","PREDNISONE ","TAB 50MG","2","Select","Select",""],["","11917017966","ARTHRTS ","TAB 650MG","30","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","65862019301","FLUOXETINE ","CAP 20MG","30","Select","Select",""],["","00078069620","ENTRESTO ","TAB 97-103MG","60","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":""}]}]}