{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROL HARRIS","gend":1,"add":"10604 REDBIRD LANE","city":"SPOTSYLVANIA","state":"VA","zip":"22553-7755","dob":"1989-06-19","age":"","mstatus":"","insh":5718217,"cliId":"","pno":5405078178,"cno":5405078178,"email":"","ename":"","eno":"","pphy":"GALDAMEZ, GLORIA E","ppno":5408345440,"pcpadd":"12101 Carol Ln, ","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224076101,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"10604 REDBIRD LANE","madd2":"                                                            ","madd3":"","mcity":"SPOTSYLVANIA","mstate":"VA","mzip":"22553-7755","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O21.2","R11.2","O99.282","E86.0","O99.89","R19.7","Z3A.23","Z90.89","O99.332","F17.210","Z91.048","Z32.01","O26.893","R10.2","T81.89XA","K57.20","R18.8","O90.0","Z48.01","O21.9","Z39.0","O86.00","A41.9","E66.9","F41.9","R13.10","F32.9","F17.200","Z68.36","O26.891","Z3A.25","O26.892","Z3A.24","O09.32","O34.219","Z37.0","Z3A.00","O65.5","O34.211","Z3A.39","O90.89","K43.2","O99.285","E87.1","O99.335","Z98.891","O99.63","R10.33","R10.30","T81.32XA","T88.9XXA","N20.0","K52.9","T81.31XA","R10.9","F32.1","K46.9","Z53.21","O09.212","O86.09","L02.211","B95.61","O99.345","Z91.09","Z79.1","K65.1","Z45.2","Z11.59","K57.32","N83.202","O69.81X0","N73.6","Y83.2","K59.00","Z88.9","S36.439A","Z79.2","K57.00"],"date":["2020-01-31","2020-01-31","2020-01-31","2020-01-31","2020-05-24","2020-01-31","2020-01-31","2020-01-31","2020-02-06","2020-07-18","2020-02-06","2020-01-31","2020-01-31","2020-02-07","2020-08-27","2021-04-08","2021-04-06","2020-09-03","2020-09-03","2020-01-31","2020-05-20","2020-06-18","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2020-02-06","2020-02-06","2020-02-07","2020-02-07","2020-02-07","2020-05-18","2020-05-18","2020-05-18","2020-05-18","2020-05-18","2020-05-18","2020-05-24","2020-05-24","2020-05-24","2020-05-24","2020-06-11","2020-05-24","2020-05-24","2020-05-24","2021-04-06","2020-05-24","2020-06-11","2020-06-11","2020-06-11","2020-05-24","2021-04-06","2020-06-30","2021-04-06","2020-02-06","2020-02-06","2020-06-11","2020-07-22","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2020-06-12","2020-06-22","2020-07-18","2021-04-05","2021-04-05","2020-05-18","2020-05-18","2020-05-24","2020-05-24","2020-05-24","2020-05-24","2020-06-22","2021-04-05"],"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":[["","69097083305","SERTRALINE ","TAB 25MG","90","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","15","Select","Select",""],["","59779054462","ARTHRTS ","TAB 650MG","15","Select","Select",""],["","42858030101","HYDROMORPHON ","TAB 2MG","10","Select","Select",""],["","67877031901","IBUPROFEN ","TAB 400MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","21","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","30","Select","Select",""],["","45802048678","DOCUSATE ","CAP 100MG","15","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":""}]}]}