{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALEXIS   B LINEBERRY","gend":1,"add":"116 BRINKLEY LANE","city":"CHILHOWIE","state":"VA","zip":"24319-6016","dob":"1996-03-07","age":"","mstatus":"","insh":7508874,"cliId":"","pno":2767809040,"cno":2766850828,"email":"","ename":"","eno":"","pphy":"STIEFEL, BRIAN H","ppno":2767837167,"pcpadd":"1020 Terrace Dr, Ste 100","pcpcity":"Marion","pcpstate":"VA","pcpzip":243544392,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":2766850828,"add2":"                                                            ","add3":"","madd1":"116 BRINKLEY LANE","madd2":"                                                            ","madd3":"","mcity":"CHILHOWIE","mstate":"VA","mzip":"24319-6016","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N63.0","Z12.4","A41.9","N12","E87.1","E87.2","D69.6","F17.210","B96.20","F32.9","F41.9","Z87.440","Z90.49","Z79.899","R10.9","R50.9","R39.89","B37.3","M54.42","M54.5","M54.41","N39.0","R31.9","Z72.0","N30.01","R30.0","R39.15","N63.10","N30.00","N10","Z01.411","N60.19","R05"],"date":["2019-09-19","2019-10-01","2019-11-07","2019-11-08","2019-11-07","2019-11-07","2019-11-07","2020-07-18","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-11-07","2019-12-28","2019-12-28","2020-07-18","2020-07-18","2020-07-18","2019-03-29","2019-03-29","2019-03-29","2021-03-05","2021-03-05","2021-03-05","2019-09-19","2021-03-05","2019-11-07","2019-09-27","2019-09-27","2019-11-07"],"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":[["","16714069211","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","68645052254","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","65162047810","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","31722072250","LEVOFLOXACIN ","TAB 500MG","7","Select","Select",""],["","65162027250","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","65862017760","CEFDINIR ","CAP 300MG","21","Select","Select",""],["","80777027399","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":[[["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":""}]}]}