{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALICIA   M REYNOLDS","gend":1,"add":"7049 MARIE LANE","city":"MECHANICSVILLE","state":"VA","zip":"23111-3330","dob":"1973-07-15","age":"","mstatus":"","insh":6291003,"cliId":"","pno":8042580098,"cno":8043862092,"email":"","ename":"","eno":"","pphy":"SMITH, JENNIFER G","ppno":8047641253,"pcpadd":"8200 Meadowbridge Rd, Ste 306","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":231162337,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEMORIAL REGIONAL ","ano":8043862092,"add2":"                                                            ","add3":"","madd1":"7049 MARIE LANE","madd2":"                                                            ","madd3":"","mcity":"MECHANICSVILLE","mstate":"VA","mzip":"23111-3330","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","N95.1","Z12.4","Z90.711","Z11.51","E03.9","Z79.890","E78.2","I10","E11.9","R53.83","E55.9","J18.9","F17.200","E66.01","Z68.35","Z12.31","J10.89","J20.9","F31.81","Z68.34","M65.311","M79.644","N39.0","R31.9","F90.9","Z11.59","G47.30","R07.81","Z13.29","B37.3","Z71.3","R30.0","R23.2","N76.0","Z51.81","J01.00","Z72.0","H66.92","M54.41","J45.20","Z80.0","R07.89"],"date":["2020-06-30","2021-01-26","2020-06-30","2020-06-30","2020-06-30","2020-12-08","2019-05-09","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2020-03-04","2021-05-12","2021-05-12","2021-01-26","2020-07-17","2019-03-14","2019-03-14","2021-05-12","2021-05-12","2021-03-30","2020-06-12","2021-02-03","2021-02-03","2021-05-12","2021-05-12","2021-05-12","2020-01-01","2020-06-30","2020-12-08","2021-01-26","2020-06-30","2020-06-30","2020-12-08","2020-12-08","2020-02-08","2020-02-08","2020-02-08","2019-02-11","2019-02-11","2019-02-11","2020-01-01"],"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":[["","68180051703","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","66993066430","DULOXETINE ","CAP 60MG","60","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","00093834410","GLYBURIDE ","TAB 5MG","30","Select","Select",""],["","68382075810","METFORMIN ","TAB 500MG","60","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","60","Select","Select",""],["","43547030403","ARIPIPRAZOLE ","TAB 10MG","30","Select","Select",""],["","00555097302","AMPHET\/DEXTR ","TAB 20MG","90","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","31722070530","VALACYCLOVIR ","TAB 1GM","30","Select","Select",""],["","00378180310","LEVOTHYROXIN ","TAB 50MCG","90","Select","Select",""],["","00574110404","BROM\/PSE\/DM ","SYP ","118","Select","Select",""],["","23155000810","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","33332031901","AFLURIA ","INJ 2019-20","0.5","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","5","Select","Select",""],["","13811071910","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","69238116609","DOXEPIN ","10MG","60","Select","Select",""],["","80777027310","MODERNA ","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":""}]}]}