{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANOLA   D STANLEY","gend":1,"add":"8314 GILLIAM HOLLOW ROAD","city":"POUND","state":"VA","zip":"24279-3330","dob":"1989-06-21","age":"","mstatus":"","insh":7508126,"cliId":"","pno":2767965350,"cno":2767965350,"email":"","ename":"","eno":"","pphy":"CAMPBELL, JAMES","ppno":2766791286,"pcpadd":"1014 PARK AVE NW, ","pcpcity":"NORTON","pcpstate":"VA","pcpzip":242731823,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"8314 GILLIAM HOLLOW ROAD","madd2":"                                                            ","madd3":"","mcity":"POUND","mstate":"VA","mzip":"24279-3330","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L73.9","R53.83","R51","F41.9","F32.9","N61.1","K05.219","F17.210","L72.3","Z83.3","N95.1","R87.610","L70.0","Z79.899","Z68.28","Z12.4","L70.8","M54.5","N94.5","J02.9","J06.9","J02.0","A41.9","K04.7","Z01.89","A60.9","B37.3","N39.0","R10.9","E28.2"],"date":["2019-11-11","2020-02-18","2020-02-18","2020-05-19","2020-05-19","2019-08-30","2019-08-29","2021-04-22","2019-08-29","2019-08-29","2020-01-06","2020-05-13","2020-05-13","2020-05-13","2020-05-13","2020-01-06","2020-05-19","2020-05-19","2020-01-09","2021-05-11","2021-05-11","2019-07-12","2019-08-29","2020-04-20","2020-01-06","2020-01-06","2020-01-06","2021-04-22","2021-04-22","2020-01-13"],"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":[["","65862037401","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","00093005401","BUSPIRONE ","TAB 10MG","60","Select","Select",""],["","00378427577","VALACYCLOVIR ","TAB 500MG","30","Select","Select",""],["","16729022601","SPIRONOLACT ","TAB 50MG","30","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","51660052605","ALLERGY ","TAB 10MG","30","Select","Select",""],["","68645056259","IBUPROFEN ","TAB 600MG","60","Select","Select",""],["","00093312301","DICLOXACILL ","CAP 250MG","56","Select","Select",""],["","60432027516","BROM\/PSE\/DM ","SYP ","120","Select","Select",""],["","62135098505","DOXYCYCL ","CAP 100MG","30","Select","Select",""],["","42571016201","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","11822331520","LORATADINE ","TAB 10MG","30","Select","Select",""],["","68462018022","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","24385060271","MUCUS ","TAB 400MG","42","Select","Select",""],["","46122033765","GNP ","TAB 95MG","10","Select","Select",""],["","00168025846","CLOTRIM\/BETA ","CRE DIPROP","45","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","55111014512","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","59746017310","PREDNISONE ","10MG","24","Select","Select",""],["","68462019005","NAPROXEN ","500MG","14","Select","Select",""],["","43386048026","ORPHENADRINE ","100MG ER","14","Select","Select",""],["","00406012410","HYDROCO\/APAP ","7.5-325","7","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","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":""}]}]}