{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CURTIS REECE","gend":0,"add":"223 SULPHUR SPRINGS ROAD","city":"PENNINGTON GAP","state":"VA","zip":"24277-8047","dob":"2001-10-02","age":"","mstatus":"","insh":7525719,"cliId":"","pno":2762076249,"cno":2762076249,"email":"","ename":"","eno":"","pphy":"LITTON JR, JOHN S","ppno":2765464894,"pcpadd":"1800 Combs Rd, Ste 7","pcpcity":"PENNINGTON GAP","pcpstate":"VA","pcpzip":242771808,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"223 SULPHUR SPRINGS ROAD","madd2":"                                                            ","madd3":"","mcity":"PENNINGTON GAP","mstate":"VA","mzip":"24277-8047","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L60.0","J45.909","Z82.49","Z82.5","Z83.3","Z80.8","R10.9","A04.5","R19.7","D58.0","R11.10","R17","R50.9","J30.2","Z23","J45.20","A08.4","E86.0","R11.2","I95.9","L03.031","E80.6","D69.6","Q87.40","J06.9","R05","J30.9","R21","L08.9","N17.9","E80.7","Z79.899","Z88.0","K52.9","E80.4","R16.1","Z86.2","R18.8","Z00.00","R52","J02.9"],"date":["2019-07-24","2019-09-13","2019-09-13","2019-07-24","2019-07-24","2019-07-24","2019-09-16","2019-09-14","2019-09-13","2019-10-31","2019-09-13","2019-09-14","2019-09-16","2021-01-28","2019-10-21","2021-01-28","2019-09-13","2019-09-13","2019-09-13","2019-09-16","2019-07-17","2019-09-14","2019-09-14","2019-09-14","2019-12-31","2019-12-31","2020-07-23","2020-11-24","2020-11-24","2019-09-13","2019-09-13","2019-09-13","2019-09-13","2019-09-13","2019-12-24","2019-12-24","2019-12-24","2019-09-13","2019-10-31","2019-12-23","2019-12-23"],"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":[["","13668008030","MONTELUKAST ","CHW 5MG","30","Select","Select",""],["","11534016503","FOLIC ","TAB 1MG","30","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00168008031","HYDROCORT ","CRE 0.025","30","Select","Select",""],["","51672213108","LORATADINE ","SOL 5MG\/5ML","300","Select","Select",""],["","76204020025","ALBUTEROL ","NEB 0.00083","75","Select","Select",""],["","00186037220","SYMBICORT ","AER 80-4.5","10.2","Select","Select",""],["","63824000834","MUCINEX ","TAB 600MG ER","40","Select","Select",""],["","55111012701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","68180044101","CEPHALEXIN ","SUS 250\/5ML","300","Select","Select",""],["","11523719702","CLARITIN ","SYP 5MG\/5ML","120","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":""}]}]}