{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LORA   M JACKSON","gend":1,"add":"251 COBURN COURT","city":"PEMBROKE","state":"VA","zip":"24136-3544","dob":"1990-05-23","age":"","mstatus":"","insh":7756301,"cliId":"","pno":5402352261,"cno":5409217511,"email":"","ename":"","eno":"","pphy":"GLENNEY, ROBERT","ppno":5402541239,"pcpadd":"18080 Main St, ","pcpcity":"Buchanan","pcpstate":"VA","pcpzip":240665482,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5409217511,"add2":"APARTMENT E","add3":"","madd1":"251 COBURN COURT","madd2":"APARTMENT E","madd3":"","mcity":"PEMBROKE","mstate":"VA","mzip":"24136-3544","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z02.83","R07.81","S09.90XA","R10.9","R51","R68.83","F41.1","F17.210","Z79.899","S37.031A","V80.010D","M79.631","S59.911A","W01.0XXA","Y93.K1","Y92.89","R44.2","M54.5","W19.XXXA","W55.19XA","Z87.828","F11.14","F22","F41.8","R11.0","Z03.89","F19.94","N72","S37.091D","S37.019D","N39.0","S37.031D","X58.XXXD","M25.552","Y92.9","F41.9","F32.9","J01.00","S37.051A","M79.601","Z91.89","F33.1","Z76.89","F33.3","Z68.41","F15.10","E87.6","R82.90","Z72.0","Z80.3","Z82.49","R87.810","R87.610","F19.251","F23","Z00.8","F19.10","Z78.1","R19.7","R68.89","Z01.419","L03.115","W57.XXXA","F60.0","G43.909","F15.90","Z30.430","Z32.02","M53.3","R00.0"],"date":["2019-05-08","2019-05-11","2019-05-11","2019-05-12","2019-05-11","2019-05-11","2020-01-09","2020-11-02","2020-01-09","2019-05-12","2019-05-12","2019-09-12","2019-09-12","2020-09-27","2019-09-12","2019-09-12","2019-11-30","2020-09-27","2020-09-27","2019-05-11","2019-07-01","2019-11-30","2019-11-30","2019-11-30","2019-05-11","2019-06-28","2019-11-30","2020-05-11","2019-06-14","2019-06-14","2019-06-14","2019-07-01","2019-07-01","2020-09-27","2020-09-27","2020-09-27","2020-09-27","2020-11-02","2019-05-12","2019-09-12","2020-01-09","2020-01-09","2020-01-09","2019-12-06","2019-12-05","2019-12-06","2019-12-05","2019-12-05","2019-12-05","2019-12-05","2019-12-05","2020-05-11","2020-05-11","2019-12-05","2019-12-04","2019-12-04","2019-12-04","2019-12-04","2020-02-06","2020-02-06","2020-04-24","2019-03-21","2019-03-21","2019-12-04","2019-12-05","2019-12-05","2020-05-07","2020-05-07","2020-09-27","2021-01-06"],"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":[["","67877022310","GABAPENTIN ","CAP 300MG","120","Select","Select",""],["","16714035201","FLUOXETINE ","CAP 20MG","90","Select","Select",""],["","00143924920","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","66993068030","OLANZAPINE ","TAB 2.5MG","30","Select","Select",""],["","43547028210","ESCITALOPRAM ","TAB 20MG","30","Select","Select",""],["","68645056354","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","00185067405","HYDROXYZ ","CAP 25MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","10006070023","VITAMIN ","TAB 500MCG","30","Select","Select",""],["","00065924007","DUREZOL ","EMU 0.0005","5","Select","Select",""],["","69543038810","KETOROLAC ","TAB 10MG","10","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","15","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":""}]}]}