{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN BIGELOW","gend":0,"add":"348 BELLE PLAINS ROAD","city":"FREDERICKSBURG","state":"VA","zip":"22405-3434","dob":"1976-12-03","age":"","mstatus":"","insh":7153925,"cliId":"","pno":5409936684,"cno":5409936684,"email":"","ename":"","eno":"","pphy":"JOSEPH, CHERIAN","ppno":5402424141,"pcpadd":"101 Hospital Center Blvd, ","pcpcity":"Stafford","pcpstate":"VA","pcpzip":225546200,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"348 BELLE PLAINS ROAD","madd2":"                                                            ","madd3":"","mcity":"FREDERICKSBURG","mstate":"VA","mzip":"22405-3434","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K62.9","K62.5","Z80.0","K62.1","F17.200","Z88.0","C20","C19","Z08","Z51.0","Z92.3","Z92.21","R19.7","C78.7","C21.0","M54.9","Z85.048","K76.9","K92.2","R63.4","R53.83","D50.0","Z43.3","K56.609","N39.0","M79.10","F20.9","F10.20","Z45.2","Z79.2","R11.2","Z51.11","G89.3","D70.1","R30.0","Z93.3","R91.1","C78.00","Z23","G89.29","D72.829","K56.699","Z11.51","D70.0","Z01.812","Z01.818","M54.16","M53.3","M54.5","E86.0","C21.8","D50.9","R91.8","K76.89","Z00.00","K62.6","I96","K62.89","K56.690","I89.9","D12.8","K21.9","Z79.02","Z79.899","K56.600","F17.210","R11.0","R11.12","K63.89","M54.6","K59.09","R19.4","R12","Z79.1","D37.5","R63.8","R53.81","R60.0","Z87.898","R50.9","Z80.7","L03.113","L08.9"],"date":["2019-07-28","2019-02-04","2019-07-28","2019-02-07","2019-07-07","2019-07-28","2021-05-24","2019-02-27","2020-01-30","2019-06-13","2020-01-30","2020-01-30","2021-05-24","2021-05-24","2019-07-20","2019-07-20","2020-01-30","2021-04-14","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-05-19","2019-08-02","2019-08-02","2019-08-02","2019-08-02","2019-08-02","2019-08-02","2019-08-02","2021-05-24","2020-05-04","2021-05-24","2021-05-24","2021-05-24","2021-05-19","2020-01-20","2021-01-08","2021-05-24","2019-07-28","2019-07-28","2019-07-29","2020-02-10","2020-07-27","2020-06-03","2020-06-15","2020-06-03","2020-06-03","2019-07-07","2019-07-10","2019-07-10","2019-10-28","2020-06-03","2019-10-28","2019-01-29","2019-02-27","2019-02-27","2019-07-28","2019-02-27","2019-02-27","2019-02-07","2019-07-28","2019-03-27","2019-03-27","2019-07-28","2019-07-28","2019-08-07","2020-08-24","2021-04-14","2019-01-15","2019-01-23","2019-02-04","2019-01-23","2019-01-23","2019-02-04","2019-04-26","2019-07-07","2019-07-07","2019-07-07","2019-07-08","2019-07-28","2021-04-09","2021-04-09"],"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":[["","59746011506","PROCHLORPER ","TAB 10MG","30","Select","Select",""],["","13107003134","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","59011046010","OXYCONTIN ","TAB 60MG CR","90","Select","Select",""],["","50383066730","LIDO\/PRILOCN ","CRE 2.5-2.5%","30","Select","Select",""],["","42858010301","OXYCOD\/APAP ","TAB 7.5-325","56","Select","Select",""],["","00832059011","DIPHEN\/ATROP ","TAB ","90","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","55111015430","ONDANSETRON ","TAB 8MG","30","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","66993068130","OLANZAPINE ","TAB 5MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","00067611730","ALLERGY ","TAB 10MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","20","Select","Select",""],["","69547035302","NARCAN ","SPR ","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}