{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NIKKIANN   M WOODS","gend":1,"add":"4704 GREENBRANCH STREET","city":"PARTLOW","state":"VA","zip":"22534-9746","dob":"1998-03-23","age":"","mstatus":"","insh":6982228,"cliId":"","pno":5407356880,"cno":5407356880,"email":"","ename":"","eno":"","pphy":"GALDAMEZ, GLORIA E","ppno":5408345440,"pcpadd":"12101 Carol Ln, ","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224076101,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"4704 GREENBRANCH STREET","madd2":"                                                            ","madd3":"","mcity":"PARTLOW","mstate":"VA","mzip":"22534-9746","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O36.72X0","O26.893","R10.11","O99.613","K90.0","O99.333","F17.210","Z3A.30","R10.84","O99.824","Z37.0","O99.334","O62.3","O99.324","F12.90","Z23","Z3A.38","O99.62","Z30.9","Z30.40","Z30.42","R10.9","U07.1","Z11.52","O80","J01.90","Z20.828","O62.2","Z3A.37","L55.1","L03.115","L03.116"],"date":["2019-05-28","2019-08-07","2019-08-07","2019-08-07","2019-10-03","2019-08-07","2019-10-03","2019-08-07","2019-08-07","2019-10-03","2019-10-03","2019-10-03","2019-10-03","2019-10-03","2019-10-03","2019-10-03","2019-10-03","2019-10-03","2020-10-09","2019-11-18","2021-04-30","2019-08-07","2021-05-23","2021-05-23","2019-10-03","2020-11-22","2020-07-29","2019-10-03","2019-09-30","2021-05-20","2021-05-20","2021-05-20"],"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":[["","68645056259","IBUPROFEN ","TAB 600MG","16","Select","Select",""],["","00703680101","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","65862044830","VALACYCLOVIR ","TAB 500MG","6","Select","Select",""],["","16714043901","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","59779017653","ALLERGY-D ","TAB 5-120MG","12","Select","Select",""],["","49035073007","MICONAZOLE ","CRE 0.02","45","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","12","Select","Select",""],["","00143992801","CIPROFLOXACN ","500MG","14","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":""}]}]}