{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEILEE   S JUDE","gend":1,"add":"2173 BYRNES CHAPEL ROAD","city":"BLAND","state":"VA","zip":"24315-5175","dob":"2002-12-04","age":"","mstatus":"","insh":6935298,"cliId":"","pno":5408186590,"cno":5408186590,"email":"","ename":"","eno":"","pphy":"COLLINS, ANN S","ppno":5406395188,"pcpadd":"3700 S MAIN ST, Ste A","pcpcity":"BLACKSBURG","pcpstate":"VA","pcpzip":240607017,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"260 CROOKED HOLLOW ROAD","add3":"","madd1":"2173 BYRNES CHAPEL ROAD","madd2":"260 CROOKED HOLLOW ROAD","madd3":"","mcity":"BLAND","mstate":"VA","mzip":"24315-5175","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E04.1","F11.10","N39.0","Z72.51","R68.89","R63.4","R79.89","E04.2","E89.0","Z77.9","Z12.4","R87.610","E05.90","Z90.89","R94.6","E03.9","F32.9","F19.11","F31.9","Z72.3","Z68.1","B18.2","B19.10","Z00.121","Z71.89","Z70.8","E03.8","E34.9","E05.10","Z01.419","Z20.9","Z86.19","F12.90","E23.0","Z30.09","N76.0","Z20.2","F55.8"],"date":["2019-04-15","2020-06-12","2020-02-21","2020-02-21","2020-02-21","2020-07-28","2020-07-28","2020-10-27","2020-02-11","2019-11-08","2019-12-18","2019-12-18","2020-02-10","2020-02-10","2020-04-07","2020-10-27","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2019-11-08","2019-11-08","2019-11-08","2019-11-08","2019-12-18","2020-08-03","2020-08-03","2019-04-15","2019-12-18","2019-12-18","2020-01-29","2019-12-18","2020-07-28","2019-04-15","2019-12-18","2020-02-24","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":[["","00548540000","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","00378180310","LEVOTHYROXIN ","TAB 50MCG","30","Select","Select",""],["","50111064801","FLUOXETINE ","CAP 20MG","30","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","68180016106","AZITHROMYCIN ","TAB 500MG","2","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":""}]}]}