{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TABITHA   A LINKOUS","gend":1,"add":"3692 ALLEGHANY SPRINGS ROAD","city":"SHAWSVILLE","state":"VA","zip":"24162-1620","dob":"1985-06-27","age":"","mstatus":"","insh":7505523,"cliId":"","pno":5404940099,"cno":5404940099,"email":"","ename":"","eno":"","pphy":"BEATO, GREGORY C","ppno":5409513311,"pcpadd":"810 Hospital Dr, ","pcpcity":"Blacksburg","pcpstate":"VA","pcpzip":240607023,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"3692 ALLEGHANY SPRINGS ROAD","madd2":"                                                            ","madd3":"","mcity":"SHAWSVILLE","mstate":"VA","mzip":"24162-1620","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","M54.2","S16.1XXA","V49.50XA","Y92.410","S39.012A","S09.8XXA","M79.601","V87.7XXA","R10.13","R11.2","R19.7","Z09","K92.0","R23.2","F11.20","Z79.899","Z01.419","Z51.81","Z03.89","F42.9","F41.9","K21.9","F17.200","R10.31","R10.9","G89.29","R11.0","J06.9","R51","R10.84","R11.10","K92.1","R42","E89.40","J02.9","J01.00","M79.10"],"date":["2019-01-23","2019-02-15","2019-02-15","2019-02-15","2019-02-15","2019-02-15","2019-02-15","2019-02-15","2019-02-15","2019-04-04","2019-04-04","2019-04-04","2019-06-14","2019-06-14","2019-06-14","2019-10-31","2019-04-17","2020-10-16","2019-10-31","2019-10-31","2019-04-04","2019-11-17","2019-04-04","2019-11-17","2019-11-17","2019-11-17","2019-11-17","2019-11-17","2019-10-12","2019-02-15","2019-04-04","2019-04-04","2019-04-04","2019-04-04","2019-05-17","2020-02-25","2020-02-25","2020-02-25"],"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":[["","42806008701","ESTRADIOL ","TAB 0.5MG","30","Select","Select",""],["","59762040105","SUCRALFATE ","TAB 1GM","56","Select","Select",""],["","57237007530","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","00115180302","HYDROXYZ ","CAP 25MG","90","Select","Select",""],["","50228011505","FLUOXETINE ","CAP 40MG","30","Select","Select",""],["","00527133010","BACLOFEN ","TAB 10MG","20","Select","Select",""],["","29300012410","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","00603158658","PROMETHAZINE ","SYP DM","75","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","80777027310","MODERNA ","COVID-19","0.5","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":""}]}]}