{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FELICIA HUNNELL","gend":1,"add":"125 BROWN BOTTOM ROAD                                       ","city":"CEDAR BLUFF                   ","state":"VA","zip":"24609-9127","dob":"1995-05-03","age":"","mstatus":"","insh":7546950,"cliId":"","pno":2769717367,"cno":2769717367,"email":"","ename":"","eno":"","pphy":"MOTOS, RAMON                                                ","ppno":"","pcpadd":"1 Clinic Dr","pcpcity":"Richlands                     ","pcpstate":"VA","pcpzip":246411102,"pcpcounty":"","pcpid":"P0060216","pcpname":"CLINCH VALLEY PHYSICIANS ASSOCIATES LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"LOT 1                                                       ","add3":"","madd1":"125 BROWN BOTTOM ROAD                                       ","madd2":"LOT 1                                                       ","madd3":"","mcity":"CEDAR BLUFF                   ","mstate":"VA","mzip":"24609-9127","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z39.1","Z34.82","Z34.83","O99.332","F17.210","Z29.13","O35.0XX0","Z3A.24","Z13.1","J10.1","R05","R11.2","O47.03","O26.893","O99.333","Z3A.29","Z3A.28","K29.70","Z3A.30","O99.613","R10.9","O26.899","R42","Z3A.31","R10.2","O09.293","Z3A.34","Z3A.35","O98.313","A74.9","Z3A.36","O26.853","Z3A.38","Z3A.37","O80","Z37.0","O99.334","Z39.2","R68.83","O90.89","R51","R00.2","O99.89","R00.1","O99.335","R55","I49.9","R06.02","I45.5","E03.9","O99.285","Z30.09","I49.49","F41.9","F32.9","Z09","R06.00","F41.0","I49.1","Z30.430","Z30.431","R87.610","N94.0","B34.9","Z30.432","N94.6","O26.851","Z3A.01","Z34.80","Z36.89","O36.80X0","Z34.81","B37.0","O98.312","O98.812","O36.0930","R19.7","Z3A.32","K08.89","O69.1XX0","Z3A.39","O69.81X0","N91.2","R50.9","R10.31","Z11.52","N92.1","N85.2","N83.201","Z97.5"],"date":["2019-01-04","2020-12-15","2021-03-24","2020-12-15","2021-03-25","2021-01-13","2019-01-31","2020-12-15","2020-12-15","2019-02-04","2019-02-04","2019-02-04","2019-02-25","2021-03-09","2021-03-24","2019-02-24","2021-01-13","2019-03-13","2021-01-27","2021-02-10","2021-02-10","2021-02-10","2019-06-05","2019-03-18","2021-10-28","2021-02-10","2021-03-09","2019-04-15","2019-04-24","2020-11-16","2019-04-24","2019-04-29","2021-03-24","2019-05-02","2021-03-25","2021-03-25","2021-03-25","2021-04-20","2019-05-07","2019-06-04","2019-06-22","2019-06-04","2019-06-02","2019-06-27","2019-06-04","2019-06-05","2019-06-04","2021-08-21","2019-06-05","2019-06-17","2019-06-17","2021-05-12","2019-06-19","2019-06-24","2019-06-19","2019-06-19","2019-06-22","2019-06-24","2019-06-27","2021-06-16","2021-09-07","2020-01-15","2019-12-13","2020-03-25","2021-10-28","2020-07-07","2020-08-11","2020-08-11","2020-08-05","2021-03-24","2020-08-11","2020-09-15","2020-11-11","2020-11-16","2020-11-16","2021-01-13","2021-02-04","2021-02-04","2021-02-10","2021-03-25","2021-03-25","2021-03-25","2021-06-02","2021-08-21","2021-09-07","2021-09-22","2021-10-28","2021-10-28","2021-10-28","2021-10-28"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","",null,null,null,null,null]}},{"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":[["","51672126302","NYSTAT\/TRIAM","","30","Select","Select",""],["","00555077902","MEDROXYPR","10MG","10","Select","Select",""],["","59762307002","AZITHROMYCIN","500MG","2","Select","Select",""],["","76439033130","VIRT-C","","30","Select","Select",""],["","60258018101","HEMATINIC\/FA","","30","Select","Select",""],["","60432053716","NYSTATIN","100000","140","Select","Select",""],["","42571016201","AMOX\/K","875-125","20","Select","Select",""],["","00000000000","","","3","Select","Select",""],["","51672126302","NYSTAT\/TRIAM ","CRE ","30","Select","Select",""],["","00555077902","MEDROXYPR ","TAB 10MG","10","Select","Select",""],["","59762307002","AZITHROMYCIN ","TAB 500MG","2","Select","Select",""],["","76439033130","VIRT-C ","CAP ","30","Select","Select",""],["","60258018101","HEMATINIC\/FA ","TAB ","30","Select","Select",""],["","60432053716","NYSTATIN ","SUS 100000","140","Select","Select",""],["","42571016201","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","68462073129","HAILEY ","TAB FE","28","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","",""],["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":""}]}]}