{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELIZABETH   F MEEK","gend":1,"add":"409 S BROOKS DRIVE","city":"FREDERICKSBURG","state":"VA","zip":"22408-2909","dob":"1985-09-28","age":"","mstatus":"","insh":4512803,"cliId":"","pno":5406044900,"cno":5406044900,"email":"","ename":"","eno":"","pphy":"ANDERSON, JOHN R","ppno":5407862100,"pcpadd":"12101 Carol Ln, ","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224076101,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"409 S BROOKS DRIVE","madd2":"                                                            ","madd3":"","mcity":"FREDERICKSBURG","mstate":"VA","mzip":"22408-2909","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E04.2","K85.10","R10.9","K81.1","E06.3","F90.9","I48.91","F60.3","E03.9","L40.9","E04.1","E04.0","F41.9","K27.9","N80.9","Z28.21","Z80.8","F43.10","F39","K85.90","K80.44","R11.2","R11.0","F45.8","R09.82","F31.63","R10.11","R30.0","R10.84","N13.30","F41.1","L40.0","L40.50","Z79.899","K21.9","H91.91","R31.9","N39.0","R35.0","G47.33","K20.0","R12","R11.10","R14.0","J31.0","E03.8","E55.9","R06.83","G47.61","G47.00","G25.81","F31.9","J45.909"],"date":["2021-01-25","2019-03-16","2019-03-16","2019-03-16","2021-01-19","2021-02-25","2019-03-16","2019-03-16","2021-01-19","2019-03-16","2021-01-19","2019-03-16","2019-07-09","2019-03-16","2019-03-16","2019-03-16","2019-03-16","2021-02-25","2020-04-28","2019-03-15","2019-03-15","2019-03-16","2019-07-09","2019-08-22","2019-08-22","2019-07-09","2019-04-12","2019-09-17","2019-09-17","2019-09-23","2020-06-02","2019-10-03","2019-10-03","2021-02-25","2019-08-22","2019-08-22","2019-03-12","2019-06-30","2019-06-30","2021-02-25","2019-02-06","2019-02-06","2019-02-06","2019-02-06","2019-08-22","2019-12-03","2019-12-03","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25"],"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":[["","54629794101","VITAMIN ","TAB 5000UNIT","30","Select","Select",""],["","65862052305","GABAPENTIN ","TAB 600MG","120","Select","Select",""],["","10702010201","METHYLPHENID ","TAB 20MG","90","Select","Select",""],["","65862022960","LAMOTRIGINE ","TAB 150MG","60","Select","Select",""],["","42806016005","HYDROXYZ ","TAB 25MG","28","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","21","Select","Select",""],["","00603233832","APAP\/CODEINE ","TAB 300-30MG","10","Select","Select",""],["","59572063106","OTEZLA ","TAB 30MG","60","Select","Select",""],["","70710113803","FLUCONAZOLE ","TAB 100MG","3","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","20","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","00378180510","LEVOTHYROXIN ","TAB 75MCG","30","Select","Select",""],["","65862019405","FLUOXETINE ","CAP 40MG","60","Select","Select",""],["","33342032980","TRIAMCINOLON ","CRE 0.001","80","Select","Select",""],["","43547026810","ROPINIROLE ","TAB 0.25MG","30","Select","Select",""],["","69842090001","FLUTICASONE ","SPR 50MCG","15.8","Select","Select",""],["","00832105410","BACLOFEN ","TAB 10MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00143122701","DICYCLOMINE ","TAB 20MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","15","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","12","Select","Select",""],["","69097084507","CYCLOBENZAPR ","TAB 5MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","10","Select","Select",""],["","16729020201","BUSPIRONE ","TAB 10MG","60","Select","Select",""],["","50428054089","CVS ","CAP 5000UNIT","30","Select","Select",""],["","51862032001","LIOTHYRONINE ","TAB 5MCG","30","Select","Select",""],["","42806000501","OXYCODONE ","TAB 5MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","15","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","68180030260","CEFUROXIME ","TAB 250MG","20","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":""}]}]}