{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLINTON HALE","gend":0,"add":"1041 CARICO RIDGE","city":"COEBURN","state":"VA","zip":"24230-6381","dob":"1979-08-30","age":"","mstatus":"","insh":7621225,"cliId":"","pno":2764559730,"cno":2764559730,"email":"","ename":"","eno":"","pphy":"BENTLEY, JODY B","ppno":2763288910,"pcpadd":"716 Spring Ave SE Ste 103, ","pcpcity":"Wise","pcpstate":"VA","pcpzip":242935702,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1041 CARICO RIDGE","madd2":"                                                            ","madd3":"","mcity":"COEBURN","mstate":"VA","mzip":"24230-6381","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K08.89","F11.20","Z51.81","Z79.899","N50.811","N45.1","R94.5","K76.0","R10.9","R10.30","J01.90","H92.01","R09.81","G89.29","F11.99","F15.20","F33.0","S39.011A","X58.XXXA","K02.9","F17.210","M54.9","Z72.0","R16.0","R51","F17.220","R07.81","R79.89","R10.31","N43.42","N50.3","R16.2","N28.1","K83.8","Z90.49"],"date":["2020-01-23","2019-04-10","2019-04-10","2019-04-10","2020-02-26","2020-03-17","2020-03-31","2020-03-23","2020-03-23","2020-03-23","2020-01-23","2020-01-23","2020-01-23","2019-02-26","2020-05-05","2020-05-05","2020-05-05","2020-02-26","2020-02-26","2019-02-26","2019-02-26","2019-02-26","2020-02-26","2020-06-23","2019-01-29","2019-02-26","2020-02-26","2020-06-23","2020-02-26","2020-02-26","2020-02-26","2020-03-31","2020-03-31","2020-03-31","2020-03-31"],"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":[["","00093117410","PENICILLN ","TAB 500MG","28","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","6","Select","Select",""],["","50383077504","LIDOCAINE ","SOL 2% VISC","100","Select","Select",""],["","59762219803","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","7","Select","Select",""],["","51224000150","BENZONATATE ","CAP 200MG","20","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","12","Select","Select",""],["","65162041503","BUPREN\/NALOX ","SUB 8-2MG","6","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":""}]}]}