{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHELLE   D FERGUSON","gend":1,"add":"3873 BROOKSIDE ROAD","city":"AXTON","state":"VA","zip":"24054-2811","dob":"1993-09-21","age":"","mstatus":"","insh":6912367,"cliId":"","pno":2762246117,"cno":2762246117,"email":"","ename":"","eno":"","pphy":"AARON, CAREN T","ppno":2766660452,"pcpadd":"319 Hospital Dr Ste 101, ","pcpcity":"Martinsville","pcpstate":"VA","pcpzip":241121928,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"3873 BROOKSIDE ROAD","madd2":"                                                            ","madd3":"","mcity":"AXTON","mstate":"VA","mzip":"24054-2811","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L02.414","E86.0","R11.0","F19.10","F11.20","R82.5","L02.11","M54.2","F17.210","F11.10","F32.9","Z71.51","R53.81","M79.606","L03.221","R41.82","D64.9","F12.10","J18.9","J90","J96.01","F19.90","Z20.828","E87.6","F41.9","Z79.899","J18.1","R06.00","R91.8","F31.9","F41.0","L03.011","W54.0XXA","R22.1"],"date":["2019-08-01","2019-08-01","2019-08-01","2020-09-29","2020-07-22","2020-07-22","2020-08-25","2020-08-25","2020-11-17","2020-11-17","2020-11-17","2019-07-31","2019-08-01","2019-08-01","2020-09-29","2019-08-01","2019-08-27","2019-08-01","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2019-08-27","2019-08-27","2019-12-26","2019-12-26","2020-08-25"],"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":[["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","00591544210","PREDNISONE ","TAB 10MG","9","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","15","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","12","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","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":""}]}]}