{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACLYN   D JANEY","gend":1,"add":"220 8TH STREET","city":"VINTON","state":"VA","zip":"24179-4837","dob":"1980-06-03","age":"","mstatus":"","insh":4550793,"cliId":"","pno":2762292151,"cno":2762292151,"email":"","ename":"","eno":"","pphy":"MARSHALL, KATHLEEN MICHELLE","ppno":8047446310,"pcpadd":"9930 Independence Park Dr, Ste 101","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232331475,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5402045066,"add2":"APARTMENT D9","add3":"","madd1":"220 8TH STREET","madd2":"APARTMENT D9","madd3":"","mcity":"VINTON","mstate":"VA","mzip":"24179-4837","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J34.89","F31.9","R51","Z88.0","Z93.1","Z09","F11.20","Z79.899","Z51.81","R50.9","J15.9","F31.4","N89.8","M65.4","Z20.828","J20.9","Z23","M54.42","M54.41","G89.29","B37.0","F19.11","M79.641","D50.9","J30.89","F43.10","F42.9","F33.2","F51.5","G47.00","J40","R09.89","R63.4","Z72.0","F32.9","K51.919","Z87.898","R03.0","Z12.4","M25.531","K02.9"],"date":["2019-01-17","2019-01-17","2019-01-17","2019-01-17","2019-01-17","2019-02-08","2021-05-18","2020-05-26","2020-05-26","2020-02-04","2020-02-04","2021-05-17","2019-05-10","2019-12-16","2019-01-28","2019-09-05","2019-10-28","2019-10-28","2019-10-28","2019-10-28","2021-04-22","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2019-01-21","2019-01-21","2019-01-21","2019-01-21","2019-01-21","2019-02-19","2019-02-19","2019-02-26","2019-05-10","2019-02-26","2019-02-26","2019-02-26","2019-05-10","2019-05-10","2019-05-10","2021-02-09"],"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":[["","12496120803","SUBOXONE ","MIS 8-2MG","25","Select","Select",""],["","57664049983","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","120","Select","Select",""],["","70954001910","PRAZOSIN ","CAP 1MG","30","Select","Select",""],["","70074056501","ENSURE ","LIQ BBRY\/POM","1,184.00","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","55111029136","SUMATRIPTAN ","TAB 25MG","6","Select","Select",""],["","45802057178","FEXOFENADINE ","TAB 180MG","30","Select","Select",""],["","00781723864","BUPREN\/NALOX ","MIS 8-2MG","13","Select","Select",""],["","70710101002","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","13107015790","PAROXETINE ","TAB 40MG","90","Select","Select",""],["","50428255042","CVS ","TAB FE\/CA\/ZN","30","Select","Select",""],["","49884093547","DICLOFENAC ","GEL 0.01","200","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","12","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","00378020810","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","00093816601","QUETIAPINE ","TAB 50MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","66689000816","NYSTATIN ","SUS 100000","140","Select","Select",""],["","60432060616","PROMETH\/COD ","SOL 6.25-10","240","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","65862053820","LEVOFLOXACIN ","TAB 750MG","7","Select","Select",""],["","67877057505","BENZONATATE ","CAP 200MG","30","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":""}]}]}