{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" KYLE R NESTER","gend":0,"add":"890 RAINDROP ROAD","city":"FANCY GAP","state":"VA","zip":"24328-4232","dob":"2000-11-28","age":"","mstatus":"","insh":7672443,"cliId":"","pno":"2767331216, 2762662513","cno":2767331216,"email":"","ename":"","eno":"","pphy":"MCGUIRE, MARIA","ppno":"               ","pcpadd":"606 E Stuart Dr, ","pcpcity":"Galax","pcpstate":"VA","pcpzip":243332317,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"890 RAINDROP ROAD","madd2":"                                                            ","madd3":"","mcity":"FANCY GAP","mstate":"VA","mzip":"24328-4232","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J18.1","D58.0","D64.9","R10.13","R17","G71.00","D65","R16.1","M25.671","M25.672","R29.3","M62.89","H10.45","R06.02","G71.09","R10.9","R09.1","R07.9","R07.89","R79.89","Z82.49","Z83.2","Z99.3","Z20.828","J18.9","F98.8","K56.7","E44.1","D58.8","R59.0","E80.6","D72.829","E87.6","E86.0","R50.9","Z82.3","Z84.89","D59.9","R06.00","R06.01","R06.09","J06.9","R05","F90.0","I51.4","H10.13","R14.0","Z01.818","R06.89","F90.2","Z23","F90.9","Z03.818","R07.2","R71.0","G47.00"],"date":["2019-01-21","2021-01-22","2019-02-06","2019-02-13","2019-02-07","2020-09-29","2019-02-07","2019-02-08","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2019-09-27","2020-11-10","2021-05-14","2019-02-07","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2019-01-24","2019-02-08","2019-02-08","2019-02-07","2019-02-07","2019-02-07","2019-02-07","2019-02-08","2019-02-07","2019-02-07","2019-02-11","2019-02-07","2019-02-07","2019-02-13","2021-03-19","2021-03-19","2019-05-10","2019-01-16","2019-01-16","2019-03-01","2020-09-29","2019-01-24","2019-02-10","2019-06-25","2019-02-11","2019-09-20","2019-09-20","2020-05-01","2020-09-29","2020-09-29","2021-01-22","2021-05-14"],"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":[["","00536035510","DSS\/SENNA ","TAB 8.6-50MG","30","Select","Select",""],["","13107007001","AMPHET\/DEXTR ","TAB 10MG","60","Select","Select",""],["","40985027416","D3 ","CAP 2000UNIT","90","Select","Select",""],["","11845014871","SENNA\/DSS ","TAB 8.6-50MG","60","Select","Select",""],["","64380080308","RANITIDINE ","TAB 150MG","60","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","",""],["No","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":""}]}]}