{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SANDRA   J ARMSDEN","gend":1,"add":"325 PARKVIEW LANE","city":"APPOMATTOX","state":"VA","zip":"24522-8228","dob":"1979-05-20","age":"","mstatus":"","insh":4513050,"cliId":"","pno":4342097305,"cno":4342097305,"email":"","ename":"","eno":"","pphy":"BROSE, TEODORA G","ppno":4343528235,"pcpadd":"131 Jones St, ","pcpcity":"Appomattox","pcpstate":"VA","pcpzip":245229830,"pcpcounty":"","pcpid":"","pcpname":"APPOMATTOX MEDICAL CENTER","ano":4346645189,"add2":"                                                            ","add3":"","madd1":"325 PARKVIEW LANE","madd2":"                                                            ","madd3":"","mcity":"APPOMATTOX","mstate":"VA","mzip":"24522-8228","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":["F33.1","H92.01","R05","F41.8","Z87.891","H66.91","H72.91","F17.210","F32.9","E66.9","Z79.899","F33.2","F15.10","N39.0","T14.91XA","T50.901A","T50.902A","F15.90","R40.0","F15.20","F13.10","F17.200","F14.21","R45.851","F41.9","F60.3","F11.11","T43.211A","T43.591A","Z91.5","Z91.19","D72.829","S81.811A","E87.6","F31.62","T42.4X1A","X83.8XXA","F19.10","Z72.0","R65.10","F39","T43.012A","Y92.009","T42.4X2A","T51.0X2A","Z68.37","R53.1","Z81.8","X78.1XXA","S71.111A","S61.512A","E78.5","Z91.14","E11.9","Z72.89","Z20.828"],"date":["2020-09-21","2019-09-26","2019-09-26","2019-09-26","2019-09-26","2019-09-30","2019-09-30","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2020-08-25","2020-08-25","2020-09-14","2019-11-18","2019-11-18","2019-11-18","2019-11-19","2019-11-18","2020-05-12","2019-01-30","2020-08-20","2020-05-11","2020-08-20","2019-11-19","2019-11-19","2019-11-19","2019-11-19","2019-11-19","2019-11-19","2019-11-19","2020-05-13","2020-05-13","2020-05-13","2020-09-29","2019-01-30","2019-01-30","2020-08-18","2020-05-12","2019-01-30","2020-09-11","2019-01-29","2019-01-29","2019-01-29","2019-01-29","2019-01-29","2019-01-29","2020-05-11","2020-05-11","2020-05-11","2020-05-11","2020-09-13","2020-09-09","2020-09-13","2020-09-09","2020-09-09"],"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":[["","43547030503","ARIPIPRAZOLE ","TAB 15MG","30","Select","Select",""],["","51991074890","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","50111043401","TRAZODONE ","TAB 100MG","60","Select","Select",""],["","16729020201","BUSPIRONE ","TAB 10MG","90","Select","Select",""],["","10370010250","BUPROPN ","TAB 300MG XL","30","Select","Select",""],["","43547034006","RISPERIDONE ","TAB 0.5MG","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","13668013701","ESCITALOPRAM ","TAB 20MG","30","Select","Select",""],["","00093506101","HYDROXYZ ","TAB 25MG","42","Select","Select",""],["","00536110788","NICOTINE ","DIS 14MG\/24H","14","Select","Select",""],["","66993068030","OLANZAPINE ","TAB 2.5MG","30","Select","Select",""],["","69097083412","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","28","Select","Select",""],["","31604002665","FISH ","CAP 1000MG","60","Select","Select",""],["","16729008110","NALTREXONE ","TAB 50MG","30","Select","Select",""],["","13668000905","CITALOPRAM ","TAB 10MG","30","Select","Select",""],["","00781185220","AMOX\/K ","TAB 875-125","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":[[["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":""}]}]}