{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" JOHN A DOAN","gend":0,"add":"1973 GRAVEL LICK ROAD","city":"CASTLEWOOD","state":"VA","zip":"24224-7153","dob":"1990-01-18","age":"","mstatus":"","insh":7730445,"cliId":"","pno":"2765656226, 2765656226","cno":"","email":"","ename":"","eno":"","pphy":"ROATSEY, THOMAS EUGENE","ppno":"               ","pcpadd":"306 SOUTH SHADY AVENUE, ","pcpcity":"DAMASCUS","pcpstate":"VA","pcpzip":242360001,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1973 GRAVEL LICK ROAD","madd2":"                                                            ","madd3":"","mcity":"CASTLEWOOD","mstate":"VA","mzip":"24224-7153","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","G47.33","Z03.818","I10","M54.5","K21.9","R00.2","R07.89","R94.39","R07.82","F41.1","F31.62","G62.9","R53.1","R61","F17.220","M79.631","M79.632","L03.113","I42.8","R06.83","F52.21","S39.001A","R10.31","R11.0","S39.002A","S39.003A","Z79.1","F32.9","N28.1","F10.21","R94.5","M54.17","R79.89","E87.6","E87.2","E83.52","F41.9","F17.200","I51.7","R00.0","R06.02","M79.641","M79.89","R50.9","S39.91XA","X58.XXXA"],"date":["2020-08-04","2020-09-04","2020-12-14","2020-08-31","2020-06-16","2020-08-04","2020-08-24","2020-08-24","2020-08-31","2019-12-05","2020-08-04","2020-08-04","2019-10-09","2019-10-09","2019-10-09","2019-12-05","2020-01-14","2020-01-14","2020-02-16","2021-04-07","2020-08-31","2020-02-11","2020-05-29","2020-05-29","2020-06-08","2020-05-29","2020-05-29","2020-05-29","2020-06-08","2020-05-29","2020-08-04","2020-08-04","2020-02-11","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-02-16","2020-02-16","2020-02-16","2020-05-29","2020-05-29"],"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":[["","65862055990","PANTOPRAZOLE ","TAB 20MG","60","Select","Select",""],["","00093100305","BUSPIRONE ","TAB 15MG","30","Select","Select",""],["","00093221005","SUCRALFATE ","TAB 1GM","120","Select","Select",""],["","57237001830","DULOXETINE ","CAP 30MG","60","Select","Select",""],["","57664037718","TRAMADOL ","TAB 50MG","90","Select","Select",""],["","43547040711","CLONAZEPAM ","TAB 1MG","60","Select","Select",""],["","31722070010","LOSARTAN ","TAB 25MG","90","Select","Select",""],["","00904679480","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","29300012601","BISOPROL ","TAB 5MG","30","Select","Select",""],["","43386048024","ORPHENADRINE ","TAB 100MG ER","20","Select","Select",""],["","16571020210","DICLOFENAC ","TAB 50MG DR","10","Select","Select",""],["","69097015815","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","63304069201","CLINDAMYCIN ","CAP 150MG","80","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":""}]}]}