{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RUTH BARBOUR","gend":1,"add":"1095 TREASURE GROVE TRAIL","city":"HUDDLESTON","state":"VA","zip":"24104-3949","dob":"1993-03-09","age":"","mstatus":"","insh":6906447,"cliId":"","pno":4345943709,"cno":4345943709,"email":"","ename":"","eno":"","pphy":"JOHNSON, MATTHEW","ppno":4342995951,"pcpadd":"125 Nationwide Dr, ","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245024272,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":4342384976,"add2":"APT. A","add3":"","madd1":"1095 TREASURE GROVE TRAIL","madd2":"APT. A","madd3":"","mcity":"HUDDLESTON","mstate":"VA","mzip":"24104-3949","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R00.0","R07.9","F41.9","M25.572","M62.81","F33.1","G90.521","G89.18","R51","S19.9XXA","M43.12","M54.16","M54.5","M76.72","M95.9","Z47.2","S92.112A","Z87.81","S32.019D","G57.72","M79.672","G89.29","G90.522","Z47.89","L02.413","S06.0X9A","M62.838","V49.49XA","Y92.410","S09.90XA"],"date":["2020-04-22","2020-04-22","2020-04-22","2020-05-12","2020-05-12","2020-06-23","2019-10-31","2019-09-26","2020-09-25","2020-09-25","2020-09-25","2020-08-28","2020-08-28","2019-09-16","2019-09-16","2019-09-16","2019-09-26","2019-09-16","2019-10-31","2019-10-31","2019-10-31","2019-10-31","2019-10-31","2019-09-16","2020-03-26","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25"],"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":[["","70010077005","METHOCARBAM ","TAB 750MG","20","Select","Select",""],["","69543038810","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","68462018022","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","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":""}]}]}