{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAZZMIN   R BROWNING","gend":1,"add":"525 HAIRSTON STREET","city":"MARTINSVILLE","state":"VA","zip":"24112-4300","dob":"2001-12-15","age":"","mstatus":"","insh":6861251,"cliId":"","pno":2762246992,"cno":2762246992,"email":"","ename":"","eno":"","pphy":"PREEDOM, AMANDA E","ppno":5406395188,"pcpadd":"202 8th St, ","pcpcity":"RADFORD","pcpstate":"VA","pcpzip":241412426,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5403209938,"add2":"APARTMENT 1","add3":"","madd1":"525 HAIRSTON STREET","madd2":"APARTMENT 1","madd3":"","mcity":"MARTINSVILLE","mstate":"VA","mzip":"24112-4300","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z03.818","N92.1","Z34.82","O09.33","Z13.1","R79.9","Z67.91","N76.0","Z11.3","O09.32","O80","Z20.828","Z00.00","Z37.0","Z3A.38","M54.5","Z04.3","W19.XXXA","F64.0","Z79.890","E27.1","D68.51","Z86.718","Z79.01","E10.40","Z79.4","F17.220","O23.42","Z3A.25","Z91.048","Z30.017","M25.551","T14.90XA","L02.91","Z34.83","O47.03","J01.80","R51.9","R32","N39.0","R10.9","R53.83","U07.1","O98.513","Z91.040","L03.115","F53.0","R06.2","Z11.59"],"date":["2020-11-15","2019-05-01","2020-03-30","2020-06-08","2020-03-30","2020-03-30","2020-03-30","2020-03-25","2020-05-12","2020-02-03","2020-06-10","2020-11-27","2020-06-08","2020-06-10","2020-06-10","2021-05-16","2020-08-09","2020-08-09","2020-08-09","2020-08-09","2020-08-09","2020-08-09","2020-08-09","2020-08-09","2020-08-09","2020-08-09","2020-08-09","2020-03-08","2020-03-08","2020-09-20","2020-08-13","2020-08-17","2020-09-20","2019-03-08","2020-05-21","2020-06-07","2021-05-16","2021-05-16","2021-05-16","2021-05-16","2021-05-16","2021-05-16","2020-06-10","2020-06-10","2020-06-10","2019-03-05","2019-03-05","2020-07-02","2020-11-16"],"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":[["","00052433001","NEXPLANON ","IMP 68MG","1","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","69097083512","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","16500009713","FLINTSTONES ","CHW COMPLETE","30","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","14","Select","Select",""],["","24658031205","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","51672130406","TERCONAZOLE ","CRE 0.004","45","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","75826011510","PHENAZOPYRID ","TAB 200MG","9","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","59762453701","MEDROXYPR ","INJ 150MG\/ML","1","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":""}]}]}