{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TYLER   J CURTIS","gend":1,"add":"411 RIDGE ROAD","city":"BERRYVILLE","state":"VA","zip":"22611-1133","dob":"1985-03-29","age":"","mstatus":"","insh":4649884,"cliId":"","pno":5404861651,"cno":5409551902,"email":"","ename":"","eno":"","pphy":"RASHID, KHURRAM","ppno":7037269401,"pcpadd":"17336 Pickwick Dr Ste A, ","pcpcity":"Purcellville","pcpstate":"VA","pcpzip":201326180,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":5409740016,"add2":"                                                            ","add3":"","madd1":"411 RIDGE ROAD","madd2":"                                                            ","madd3":"","mcity":"BERRYVILLE","mstate":"VA","mzip":"22611-1133","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R11.2","E10.10","E11.43","E10.43","K31.84","N83.202","Z79.4","Z82.5","Z83.3","Z98.51","Z87.891","Z91.19","E10.9","R10.9","D72.829","N17.9","E86.0","T38.3X6A","Z91.128","I10","Z86.32","E87.1","Z03.89","E11.9","E87.2","R11.15","E87.6","F12.90","R63.1","R06.02","R10.11","R10.12","R10.84","E11.10","F12.188","E10.65","R11.10","E43","D72.828","Z68.20","R10.13","B37.3","E83.42","Z91.14","R73.09","R61","R19.7","K02.9","Z79.82","R10.10","K59.00","Z79.899","E11.65","F17.200","R93.89","F12.10","E88.89","R10.0","Z74.3","G43.A0","R73.9"],"date":["2021-02-13","2020-09-19","2020-09-21","2020-09-19","2020-09-19","2019-07-17","2020-07-09","2020-09-19","2020-08-25","2020-09-19","2020-09-19","2020-09-19","2020-08-25","2021-02-13","2020-08-25","2020-09-19","2020-09-19","2020-01-06","2020-01-06","2020-01-10","2020-09-19","2020-09-19","2019-06-19","2020-07-08","2020-08-25","2020-08-25","2020-07-09","2021-02-13","2020-07-09","2020-09-20","2019-07-16","2019-07-16","2020-09-18","2020-09-21","2019-08-19","2020-09-21","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-07-05","2020-09-19","2020-09-19","2020-09-19","2020-09-21","2020-01-16","2019-03-20","2019-03-20","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2020-01-06","2020-01-06","2019-07-16","2020-08-25","2020-08-25","2021-02-13","2021-02-13","2019-06-19","2019-08-19"],"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":[["","00169750111","NOVOLOG ","INJ 100\/ML","10","Select","Select",""],["","00088222033","LANTUS ","INJ 100\/ML","10","Select","Select",""],["","49884068905","METOCLOPRAM ","TAB 10MG","90","Select","Select",""],["","00591079401","DICYCLOMINE ","CAP 10MG","30","Select","Select",""],["","73070010011","INSULIN ","INJ 100\/ML","10","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","60258017101","MAG ","TAB 400MG","20","Select","Select",""],["","65862001705","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","10702000350","PROMETHAZINE ","TAB 25MG","12","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","43598051010","ESOMEPRA ","CAP 40MG DR","30","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","31722088390","ROSUVASTATIN ","TAB 10MG","30","Select","Select",""],["","49100040009","CULTURELLE ","CAP ","30","Select","Select",""],["","00536100836","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","51672206200","3","CRE 0.02","21","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","00121058104","HALOPERIDOL ","CON 2MG\/ML","10","Select","Select",""],["","11917010873","KETONE ","TES ","50","Select","Select",""],["","08496310401","EASY ","MIS 31GX1\/4\"","100","Select","Select",""],["","00378456105","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","00781185220","AMOX\/K ","875-125","14","Select","Select",""],["","59676058005","JANSSEN ","COVID-19","0.5","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":""}]}]}