{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RUTH   L CLIFT","gend":1,"add":"15110 MISTY LANE","city":"KING GEORGE","state":"VA","zip":"22485-4629","dob":"1981-06-02","age":"","mstatus":"","insh":6864389,"cliId":"","pno":5404555072,"cno":5408095094,"email":"","ename":"","eno":"","pphy":"DEDWYLDER, ROSIER D","ppno":5406449505,"pcpadd":"5254 Potomac Dr, Ste C","pcpcity":"King George","pcpstate":"VA","pcpzip":224855832,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":5404129665,"add2":"                                                            ","add3":"","madd1":"15110 MISTY LANE","madd2":"                                                            ","madd3":"","mcity":"KING GEORGE","mstate":"VA","mzip":"22485-4629","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O23.02","R50.9","J18.9","J90","J98.11","Z87.891","R10.9","M54.9","M54.5","M46.50","Z33.1","O99.89","M46.58","O99.512","O99.012","D50.9","O99.282","E03.9","O99.342","F32.9","Z11.59","Z45.2","Z79.2","O09.522","O35.5XX0","M46.1","Z33.3","O98.813","O09.523","O99.283","F19.11","Z3A.27","A41.9","R65.20","D65","Z34.90","O98.812","O26.852","E87.6","E83.42","D72.829","N73.9","N89.8","R68.83","Z20.828","B37.3","O09.512","Z3A.35","O99.353","O09.511","O99.281","A77.41","M86.9","Z3A.17","O80","Z37.0","Z3A.00","O70.0","Z3A.39","O26.892","M00.9","O26.899","M79.18","O41.8X90","O09.892","Z3A.19","Z3A.23","Z3A.31","Z03.818","Z3A.16","O99.332","F17.210","O99.284","Z02.82","O99.02","D64.9","O69.82X0","O71.82","O99.824"],"date":["2020-06-13","2020-06-24","2020-07-02","2020-06-14","2020-06-14","2020-11-19","2020-06-24","2020-06-24","2020-06-29","2020-10-26","2020-06-26","2020-08-31","2020-07-02","2020-07-02","2020-07-02","2020-07-02","2020-10-26","2020-11-19","2020-07-02","2020-07-02","2020-07-02","2020-07-02","2020-07-02","2020-10-26","2020-07-06","2020-07-27","2020-07-23","2020-09-28","2020-11-12","2020-10-26","2020-08-31","2020-08-31","2020-07-27","2020-06-26","2020-06-26","2020-08-05","2020-06-15","2020-06-13","2020-06-13","2020-06-15","2020-06-13","2020-06-13","2020-06-13","2020-06-13","2021-02-14","2020-08-03","2020-06-17","2020-10-26","2020-10-26","2020-05-20","2020-05-20","2020-06-15","2020-06-22","2020-06-22","2020-11-20","2020-11-20","2020-11-19","2020-11-20","2020-11-20","2020-06-19","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2020-07-06","2020-07-06","2020-08-03","2020-09-28","2021-02-14","2020-06-15","2020-06-15","2020-06-15","2020-11-19","2020-11-19","2020-11-19","2020-11-19","2020-11-19","2020-11-19","2020-11-19"],"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":[["","00603233832","APAP\/CODEINE ","TAB 300-30MG","10","Select","Select",""],["","13107003134","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","57237001930","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","65162052110","PROMETHAZINE ","TAB 25MG","30","Select","Select",""],["","00093220305","METOCLOPRAM ","TAB 10MG","90","Select","Select",""],["","00143924920","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00378180910","LEVOTHYROXIN ","TAB 100MCG","30","Select","Select",""],["","59011041010","OXYCONTIN ","TAB 10MG CR","60","Select","Select",""],["","07610010418","PRENATAL ","TAB 28-0.8MG","30","Select","Select",""],["","65162036111","FOLIC ","TAB 1MG","30","Select","Select",""],["","50428310425","STOOL ","CAP 100MG","20","Select","Select",""],["","58160084252","BOOSTRIX ","INJ ","0.5","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","20","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","00245010811","FERROUS ","TAB 325MG EC","60","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":""}]}]}