{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" JEFFREY RILEY","gend":0,"add":"190 FISHERSVILLE ROAD ","city":"FISHERSVILLE                  ","state":"VA","zip":"22939-2251","dob":"1963-08-11","age":"","mstatus":"","insh":4712434,"cliId":"","pno":"5402576420, 5402576420","cno":"","email":"","ename":"","eno":"","pphy":"FARLEY, BENJAMIN GATES        ","ppno":"               ","pcpadd":"42 Lambert St  Ste 511","pcpcity":"Staunton                      ","pcpstate":"VA","pcpzip":244012437,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"WESTERN","aligned":"","ano":"","add2":"APT C ","add3":"","madd1":"190 FISHERSVILLE ROAD    ","madd2":"APT C                                                       ","madd3":"","mcity":"FISHERSVILLE                  ","mstate":"VA","mzip":"22939-2251","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R91.8","R59.0","I10","J44.9","K21.9","F17.210","F19.11","F10.11","Z88.8","Z79.899","Z86.19","Z51.0","C34.11","Z79.1","Z72.0","Z80.1","Z80.0","Z80.42","K27.9","C34.90","Z71.6","K21.0","R10.13","Z51.11","Y84.2","Y78.1","K20.8","T66.XXXS","E86.0","R63.4","Z68.1","F32.9","Z79.52","R13.10","R07.89","C34.91","R05","R53.1","J15.9","R06.02","R64","J44.0","E46","B19.20","M62.81","M51.36","Z92.3","Z20.822","R22.2","R65.10","R10.84","K20.80","Z51.5","R13.19","Z86.59","J18.9","R62.7","Z13.89","R93.5","R16.0","K59.00","Z87.11","Z85.118","R41.82","R00.9","I95.9","R09.02","G89.3","R35.0","Z51.12","J18.8","E87.1","J44.1","Z99.81","R06.89","J98.4","Z20.828","R07.9","R04.2","R53.83","M54.9","R09.1","J43.9","D69.6","Z79.891","Z92.21","K56.41","R06.00","Z13.5","Z03.818","R00.0","D36.0","C34.10","R19.7","C34.01"],"date":["2021-02-22","2020-11-16","2021-02-24","2021-02-24","2020-07-24","2021-02-24","2020-07-24","2021-02-24","2020-12-17","2020-11-01","2020-08-26","2020-09-29","2021-02-24","2020-09-29","2020-10-27","2020-09-29","2020-09-29","2020-09-29","2020-08-24","2021-02-19","2020-12-17","2020-08-26","2020-09-15","2020-10-06","2020-12-17","2020-12-03","2020-09-30","2020-12-03","2020-12-21","2020-12-03","2020-12-17","2021-02-24","2021-02-24","2020-12-03","2020-10-04","2020-12-17","2021-02-24","2020-12-14","2021-02-01","2020-12-17","2020-12-17","2021-02-01","2021-02-01","2021-02-24","2020-12-17","2021-02-24","2021-02-24","2021-02-24","2020-07-20","2020-07-20","2020-08-24","2021-02-01","2020-12-03","2020-12-03","2020-12-03","2020-12-21","2020-12-18","2020-07-30","2020-07-30","2020-07-30","2020-12-03","2020-11-01","2021-02-24","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2020-09-02","2020-11-24","2020-12-03","2020-12-14","2020-12-14","2021-02-01","2021-02-01","2020-07-20","2020-07-20","2020-07-20","2020-10-04","2020-10-04","2020-09-15","2020-10-04","2020-10-04","2020-10-04","2020-10-04","2020-10-04","2020-10-04","2020-11-01","2020-12-17","2020-07-30","2020-12-17","2020-12-17","2020-07-24","2020-07-30","2020-10-04","2021-01-15"],"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":[["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","55111028130","LEVOFLOXACIN ","TAB 750MG","7","Select","Select",""],["","65162052111","PROMETHAZINE ","TAB 25MG","20","Select","Select",""],["","00378064210","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","00054418425","DEXAMETHASON ","TAB 4MG","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","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":""}]}]}