{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAVARIS SMITH","gend":0,"add":"SHIELA SMITH","city":"FREDERICKSBURG","state":"VA","zip":"22401-7243","dob":"2000-04-02","age":"","mstatus":"","insh":6734534,"cliId":"","pno":5407357658,"cno":5407357658,"email":"","ename":"","eno":"","pphy":"MANCINI, PAMELA","ppno":5403614779,"pcpadd":"4550 Empire Ct, ","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224081939,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"1916 HOWARD AVENUE","add3":"","madd1":"SHIELA SMITH","madd2":"1916 HOWARD AVENUE","madd3":"","mcity":"FREDERICKSBURG","mstate":"VA","mzip":"22401-7243","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E83.42","E83.51","E87.6","E03.9","E23.0","L80","Z03.818","D72.829","R79.89","X58.XXXA","E07.9","T38.1X6A","Z91.128","D84.9","E87.8","B99.9","M35.9","R19.7","R63.4","E87.4","N25.81","J45.909","K52.9","B35.1","L20.9","Z81.8","Z82.3","Z82.49","L63.9","Z79.2","Z79.899","L65.9","E03.8","R62.52","Z71.83","L30.9","L83","E83.39","L60.3","Q80.0","Z00.00","L30.8","L63.0","B37.2","B37.9","Z20.828","L20.89","F84.9","T78.40XD","J45.20","H61.23"],"date":["2021-03-09","2020-11-30","2021-03-08","2020-10-17","2020-11-30","2020-11-30","2021-05-23","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-10-08","2020-10-08","2020-11-30","2020-10-08","2020-10-08","2020-10-08","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-15","2020-10-15","2020-10-15","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-07-27","2020-07-27","2020-10-05","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2021-05-23","2019-03-18","2019-03-18","2020-09-28","2020-09-28","2020-03-23"],"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":[["","00378180310","LEVOTHYROXIN ","TAB 50MCG","90","Select","Select",""],["","75834002001","VITAMIN ","CAP 50000UNT","12","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","60","Select","Select",""],["","70461032003","FLUCLVX ","INJ 2020-21","0.5","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","18","Select","Select",""],["","00093742698","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","45802049326","AMMONIUM ","CRE 0.12","385","Select","Select",""],["","68462025265","DESONIDE ","CRE 0.0005","60","Select","Select",""],["","50428230995","ANTACID ","CHW 1000MG","72","Select","Select",""],["","45802013132","HALOBETASOL ","OIN 0.0005","50","Select","Select",""],["","00245531911","KLOR-CON ","TAB 20MEQ ER","20","Select","Select",""],["","45802001402","HYDROCORT ","OIN 0.025","20","Select","Select",""],["","45802025742","MOMETASONE ","CRE 0.001","45","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":""}]}]}