{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOSH   S SPROUSE","gend":0,"add":"1001 HOPEMAN PARKWAY","city":"WAYNSBORO","state":"VA","zip":"22980-1845","dob":"1994-06-15","age":"","mstatus":"","insh":6845275,"cliId":"","pno":5406889418,"cno":5406889418,"email":"","ename":"","eno":"","pphy":"DE LOS REYES, OCTAVIO","ppno":5408853525,"pcpadd":"40 Lambert St Ste 522, ","pcpcity":"Staunton","pcpstate":"VA","pcpzip":244012446,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT N3","add3":"","madd1":"1001 Hopeman Pkwy Apt O4","madd2":"                                                            ","madd3":"","mcity":"Waynesboro","mstate":"VA","mzip":"22980-1846","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K22.3","R10.11","R10.13","N17.9","E86.0","R11.2","R19.7","K21.9","Z79.899","Z02.89","J45.909","R55","R10.9","T48.6X6A","Z76.0","Z72.0","Z87.898","Z03.818","R06.02","F31.9","G89.18","R10.32","J98.2","F17.210","Z87.19","R93.1","R14.0","R11.0","R10.10","K22.4","R13.10","F17.200","K92.0","G89.29","F17.290","Z87.11","R10.30","R10.31","Z90.49","Z71.6","S09.90XA","R00.0","R42","F32.9","R10.0","I49.8","Z63.8","R09.81","J34.89","R04.0","R06.00","Z23","Z90.89","K35.80","R68.83","R05","Z30.2","T48.5X5A","Z20.828","R51.9","W19.XXXA","Z20.822","R10.84","R68.89","J02.9","F41.9","R07.89"],"date":["2019-06-07","2020-10-28","2020-09-01","2019-06-07","2019-06-07","2019-06-07","2019-06-07","2020-10-21","2020-10-21","2020-07-23","2020-10-21","2021-01-14","2020-11-23","2020-07-23","2020-07-23","2021-02-04","2020-07-23","2021-02-04","2020-07-30","2020-12-07","2020-10-28","2020-11-23","2019-06-07","2020-10-21","2020-11-23","2019-06-07","2019-07-31","2019-07-31","2019-08-05","2019-08-14","2019-08-14","2019-08-14","2020-09-01","2020-09-01","2020-09-01","2020-11-23","2020-10-21","2020-10-21","2020-11-23","2020-10-28","2021-01-14","2021-01-14","2021-01-14","2020-09-21","2020-11-23","2021-01-14","2021-01-14","2019-11-10","2019-11-10","2019-11-10","2020-08-03","2020-10-21","2021-02-04","2020-10-21","2020-10-28","2021-02-04","2021-04-09","2019-11-05","2020-10-21","2021-01-14","2021-01-14","2021-02-04","2020-10-21","2019-06-08","2019-08-05","2020-09-21","2020-09-21"],"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":[["","00591565810","CYCLOBENZAPR ","TAB 10MG","10","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","6","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","10","Select","Select",""],["","59746028490","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","11917016242","GAS ","CHW 125MG","120","Select","Select",""],["","00093816601","QUETIAPINE ","TAB 50MG","60","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","120","Select","Select",""],["","70710122600","AMITRIPTYLIN ","TAB 25MG","30","Select","Select",""],["","63304073530","ESOMEPRA ","CAP 40MG DR","30","Select","Select",""],["","69618003206","SIMETHICONE ","CHW 125MG","120","Select","Select",""],["","00597012281","ZANTAC ","TAB 75MG","60","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","11822505540","RA ","CHW 125MG","120","Select","Select",""],["","00536250676","SALINE ","SPR 0.0065","44","Select","Select",""],["","11822350870","SINUS ","KIT NETI POT","50","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","68462024805","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","68462039710","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","20","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","43547030303","ARIPIPRAZOLE ","TAB 5MG","30","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":""}]}]}