{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMBER   N DUNCAN","gend":1,"add":"319 COOKS KNOB ROAD","city":"FERRUM","state":"VA","zip":"24088-4325","dob":"2003-01-16","age":"","mstatus":"","insh":6927328,"cliId":"","pno":5403529364,"cno":5403529364,"email":"","ename":"","eno":"","pphy":"MCBRIDE, MARK A","ppno":5403449213,"pcpadd":"21 Highland Ave SE, Ste 100","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":240132218,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"319 COOKS KNOB ROAD","madd2":"                                                            ","madd3":"","mcity":"FERRUM","mstate":"VA","mzip":"24088-4325","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","F90.2","F34.81","F70","L03.211","T36.1X2A","T43.222A","T39.312A","F41.9","F43.10","Z11.59","F33.1","T43.201A","T14.91XA","R00.0","T43.292A","F41.0","F32.9","F40.240","J45.20","R41.83","F82","F80.2","F90.9","Z62.810","R12","Z01.419","Z11.3","Z30.42","S09.90XA","R51","H53.149","R11.2","W22.8XXA","T50.902D","F98.8","F39","Z30.017","Z32.02","F90.0","F34.9","F84.0","L03.115","R21","Z00.121","Z13.31","Z23","Z30.013","T50.901A","R07.9","T43.291A","Z91.5","Z20.828","T43.294A","R68.89","T50.912A","T50.902A","H57.04","I49.8","Z11.4","Z30.46","R06.00","N94.6","R41.89","Z81.8","Z13.220","Z30.09","Z82.41","R42","N93.9","N94.4"],"date":["2019-04-08","2020-12-10","2020-12-10","2020-12-10","2019-07-13","2020-06-27","2020-06-27","2020-06-27","2021-04-26","2020-12-02","2020-11-29","2021-03-25","2020-11-29","2020-12-02","2020-11-29","2020-12-02","2020-11-29","2020-11-29","2020-11-29","2020-12-02","2020-12-05","2020-11-29","2020-12-02","2021-04-26","2020-11-29","2020-11-29","2019-05-20","2020-07-24","2019-11-04","2020-03-05","2020-03-05","2020-03-05","2020-11-29","2020-03-05","2020-06-29","2020-06-30","2020-06-29","2020-01-14","2020-01-14","2021-05-07","2019-02-28","2020-06-28","2019-09-23","2019-09-23","2020-07-24","2020-07-24","2020-07-24","2019-05-20","2020-06-27","2020-11-29","2020-11-29","2020-12-02","2020-11-29","2020-12-03","2020-06-28","2020-06-28","2020-06-30","2020-06-30","2020-11-29","2019-05-20","2020-10-28","2020-06-28","2020-12-02","2020-12-02","2020-12-02","2019-05-09","2019-05-09","2019-05-09","2020-03-05","2020-10-28","2020-10-28"],"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":[["","00093816601","QUETIAPINE ","TAB 50MG","60","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","90","Select","Select",""],["","10370010150","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","00378827052","ALBUTEROL ","NEB 0.00083","75","Select","Select",""],["","59417010510","VYVANSE ","CAP 50MG","30","Select","Select",""],["","00555902658","JUNEL ","TAB 44216","28","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","28","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","60","Select","Select",""],["","00555901658","SPRINTEC ","TAB 28 DAY","28","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","80681014800","MELATONIN ","TAB 3MG","60","Select","Select",""],["","60505283203","ATOMOXETINE ","CAP 25MG","7","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","60505392701","GUANFACINE ","TAB 1MG ER","7","Select","Select",""],["","75826011410","PHENAZOPYRID ","TAB 100MG","6","Select","Select",""],["","13668013501","ESCITALOPRAM ","TAB 5MG","30","Select","Select",""],["","00228212750","CLONIDINE ","TAB 0.1MG","30","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","70954001910","PRAZOSIN ","CAP 1MG","30","Select","Select",""],["","47781030801","NITROFUR ","CAP 100MG","20","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","12","Select","Select",""],["","60505036302","OFLOXACIN ","0.3%OTIC","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":""}]}]}