{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALISHIA BALL","gend":1,"add":"102 ELKMONT DRIVE","city":"ELKTON","state":"VA","zip":"22827-9433","dob":"1989-01-12","age":"","mstatus":"","insh":4561276,"cliId":"","pno":5406528894,"cno":5406528894,"email":"","ename":"","eno":"","pphy":"DOMINGUS, JEFF LEWIS","ppno":5404334913,"pcpadd":"339 NEBO SCHOOL RD, ","pcpcity":"NEBO","pcpstate":"NC","pcpzip":287616848,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT 3","add3":"","madd1":"102 ELKMONT DRIVE","madd2":"APT 3","madd3":"","mcity":"ELKTON","mstate":"VA","mzip":"22827-9433","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","R51","M54.9","M25.562","V79.88XA","S16.1XXA","R10.10","M54.2","V49.9XXA","Y92.410","S39.012A","S83.92XA","S06.9X9A","R40.2412","K76.0","F14.20","Z88.0","Z88.2","Z88.8","S09.90XA","S06.0X0D","R26.89","S09.90XS","K08.89","M47.812","K04.7","R10.13","R10.9","R07.9","R11.2","Z87.442","Z88.1","S89.92XA","R30.0","K59.00","R10.84","R14.0","Z90.49","Z87.19","J02.0","R11.0","R19.7","Z90.710","S19.9XXA","S39.92XA","S29.9XXA","S39.91XA","S39.93XA","R16.1","Z88.5"],"date":["2021-05-23","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-07-24","2020-02-17","2020-07-24","2020-07-24","2020-07-24","2020-02-17","2020-07-13","2020-07-13","2020-07-13","2020-05-21","2020-06-11","2021-03-12","2019-12-19","2020-07-24","2020-02-17","2019-12-23","2020-07-24","2020-07-24","2020-02-17","2020-07-24","2019-05-21","2019-12-23","2019-12-23","2019-12-23","2019-12-23","2020-01-31","2020-07-24","2019-05-21","2019-05-21","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-02-17","2020-07-24","2020-07-24"],"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":[["","68001024617","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","00781531701","ZOLPIDEM ","TAB 5MG","7","Select","Select",""],["","43199001101","HYOSCYAMINE ","SUB 0.125MG","12","Select","Select",""],["","00591024010","LORAZEPAM ","TAB 0.5MG","2","Select","Select",""],["","51672400101","NORTRIPTYLIN ","CAP 10MG","60","Select","Select",""],["","42571016242","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","68001025320","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","18","Select","Select",""],["","13811071910","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","00054001925","PREDNISONE ","TAB 50MG","5","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","20","Select","Select",""],["","57896045101","GERI-KOT ","TAB 8.6MG","12","Select","Select",""],["","00904645780","DOK ","CAP 100MG","30","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","68180016113","AZITHROMYCIN ","TAB 500MG","3","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","20","Select","Select",""],["","51862006305","DIAZEPAM ","TAB 5MG","1","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":""}]}]}