{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DABRIELLE   R HILTON","gend":1,"add":"206 HILL AVENUE","city":"PEMBROKE","state":"VA","zip":"24136-3370","dob":"1994-03-31","age":"","mstatus":"","insh":4650748,"cliId":"","pno":5409210111,"cno":5409210111,"email":"","ename":"","eno":"","pphy":"BOONE, JOHN A","ppno":5403345511,"pcpadd":"1611 Wenonah Ave, ","pcpcity":"Pearisburg","pcpstate":"VA","pcpzip":241341839,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"206 HILL AVENUE","madd2":"                                                            ","madd3":"","mcity":"PEMBROKE","mstate":"VA","mzip":"24136-3370","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R18.8","R94.5","K70.31","K76.9","I85.10","D64.9","R06.02","R91.8","Z03.89","R94.8","K74.60","R16.2","I85.00","K70.30","K31.9","F41.9","F32.9","F17.210","R10.11","D58.9","R74.0","R60.1","F10.10","D53.9","Z72.0","R17","R00.0","K76.6","D59.1","Z01.419","Z30.017","Z32.02","R93.2","M79.89","J90","I85.11","I31.3","Z79.899","R14.0","R10.84","Z01.812","Z20.828","R10.9","D53.1","Z66","K82.8"],"date":["2020-08-18","2020-07-20","2020-08-11","2020-08-18","2020-11-11","2020-08-06","2020-07-17","2020-07-17","2020-07-18","2020-07-18","2020-08-18","2020-08-18","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-07-19","2020-07-19","2020-07-19","2020-07-19","2020-07-19","2020-07-19","2020-07-19","2020-07-19","2020-07-19","2020-07-20","2020-08-03","2019-03-04","2019-03-04","2019-03-04","2020-07-17","2020-07-18","2020-07-17","2020-07-17","2020-07-18","2020-07-17","2020-07-18","2020-07-18","2020-11-06","2020-11-06","2020-07-18","2020-07-18","2020-07-18","2020-07-18"],"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":[["","43547040211","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","59746021701","SPIRONOLACT ","TAB 50MG","60","Select","Select",""],["","11845009611","MAGNESIUM ","TAB 200MG","30","Select","Select",""],["","57896060101","THERA-TABS ","TAB ","30","Select","Select",""],["","80681000300","THEREMS ","TAB MULTIVIT","30","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","30","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","90","Select","Select",""],["","00904053913","THERA ","TAB ","30","Select","Select",""],["","68382009205","CARVEDILOL ","TAB 3.125MG","30","Select","Select",""],["","10006073021","VITAMIN ","TAB 100MG","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","",""],["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":""}]}]}