{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA   R COLLINS","gend":1,"add":"5851 DOE RUN ROAD","city":"ROCKY MOUNT","state":"VA","zip":"24151-4540","dob":"1984-11-17","age":"","mstatus":"","insh":4790892,"cliId":"","pno":5404485547,"cno":5404485547,"email":"","ename":"","eno":"","pphy":"THOMAS, JOANNA B","ppno":4343387774,"pcpadd":"1971 University Blvd, ","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245150002,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"5851 DOE RUN ROAD","madd2":"                                                            ","madd3":"","mcity":"ROCKY MOUNT","mstate":"VA","mzip":"24151-4540","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.02","R05","F41.9","F17.200","Z09","J18.9","F32.9","Z23","F12.10","F19.20","Z71.9","J40","J96.00","J44.0","J20.9","J44.1","D72.829","R00.0","F17.210","Z88.0","Z88.2","K04.7","J09.X2","R91.1","J45.909","J10.1","K08.89","Z87.891","R07.81","R07.9","R91.8","R07.89","W19.XXXA","F11.20","S20.212A","Y92.9","M79.89","Z11.59"],"date":["2019-03-24","2019-03-23","2019-03-24","2019-03-24","2019-04-01","2019-04-01","2019-04-01","2019-04-01","2019-04-01","2019-04-01","2019-04-01","2019-03-23","2019-03-23","2019-03-23","2019-03-24","2019-03-23","2019-03-23","2020-04-27","2019-03-23","2019-03-23","2019-03-23","2019-10-17","2019-03-14","2019-03-14","2020-04-27","2019-03-14","2019-10-17","2020-04-27","2020-04-27","2020-04-27","2019-03-14","2020-04-27","2020-04-27","2019-08-21","2020-04-27","2020-04-27","2020-04-27","2020-10-24"],"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":[["","31722072320","LEVOFLOXACIN ","TAB 750MG","3","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","20","Select","Select",""],["","64380071206","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","21","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","49100040009","CULTURELLE ","CAP ","10","Select","Select",""],["","11917004918","ACETAMIN ","TAB 500MG","60","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","8","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":""}]}]}