{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ABRIA   M SEELBACH","gend":1,"add":"162 W MAIN STREET","city":"FRIES","state":"VA","zip":"24330-4616","dob":"1983-03-15","age":"","mstatus":"","insh":7770847,"cliId":"","pno":2762378503,"cno":2762378503,"email":"","ename":"","eno":"","pphy":"VANDYKE, KELLY SUE","ppno":2767443660,"pcpadd":"109 Carrol Dr, ","pcpcity":"Fries","pcpstate":"VA","pcpzip":243304532,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"162 W MAIN STREET","madd2":"                                                            ","madd3":"","mcity":"FRIES","mstate":"VA","mzip":"24330-4616","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J02.9","N99.3","N95.2","Z90.710","R53.82","M62.81","R29.6","Z73.6","N89.8","J03.90","J10.1","L03.032","G35","N20.1","N23","N20.0","Z88.0","F32.9","F17.290","Z87.442","Z79.890","Z79.899","Z86.39","E66.01","Z68.41","J02.0","R05","L98.9","W57.XXXA","J35.01","H47.20","G37.8","G93.9","F41.9","M50.220","R90.82","E55.9","J30.2","J32.9","R26.81","H81.43","G47.10","E66.9","Z01.419","Z11.51","N81.5","N81.6","N94.10","F17.210","Z90.722","Z46.6","M79.10","H53.9","R51.9","R53.83","Z87.891","Z03.89","J30.9","N13.30","M54.5","R11.0","G37.9","H54.61","H53.19","F31.81","F33.9","F41.1","M48.04","G47.33","F32.0","F39","Z51.89","R06.83","I05.0","R68.2","R45.1","G47.00","N13.2","Z01.818","J01.90","F34.1","J35.1","H46.8","H35.372","H43.393","M25.552","Z92.29","Z68.38","Z71.3","Z71.82","R10.9","R30.0","R11.2","R90.89","M51.24","M50.320","J06.9","R50.9","G47.14","G47.30"],"date":["2019-11-13","2019-07-16","2019-07-16","2019-12-02","2019-10-11","2019-10-11","2019-10-11","2019-10-11","2020-01-20","2020-10-01","2021-03-02","2021-03-02","2020-12-10","2020-02-24","2020-11-01","2020-11-01","2020-11-01","2020-11-01","2020-11-01","2020-11-01","2020-02-13","2021-01-26","2020-02-13","2020-02-13","2020-02-13","2020-10-09","2020-10-09","2020-07-02","2020-07-02","2020-11-10","2020-12-09","2020-12-09","2020-12-09","2021-05-25","2019-02-24","2019-02-24","2021-01-26","2021-04-06","2019-03-15","2019-09-20","2019-09-20","2019-08-05","2021-04-06","2021-04-27","2019-08-15","2019-12-04","2019-12-04","2019-12-02","2019-12-02","2019-12-02","2020-02-24","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2021-05-05","2021-05-05","2020-02-11","2021-04-06","2020-11-01","2020-12-05","2020-12-05","2020-12-10","2021-02-23","2021-02-23","2021-02-23","2019-02-24","2019-06-10","2019-06-10","2020-11-09","2019-07-03","2019-07-22","2019-07-03","2019-07-03","2019-07-03","2019-07-03","2020-02-11","2020-11-05","2020-01-18","2020-11-09","2020-11-10","2020-11-30","2020-11-30","2020-11-30","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2020-02-11","2020-02-11","2020-02-11","2020-12-05","2019-02-24","2019-02-24","2019-09-16","2019-12-16","2019-07-22","2019-07-22"],"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":[["","00143980305","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","00555088702","ESTRADIOL ","TAB 2MG","90","Select","Select",""],["","65862001105","SERTRALINE ","TAB 25MG","30","Select","Select",""],["","62332003731","LAMOTRIGINE ","TAB 25MG","60","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","10702000350","PROMETHAZINE ","TAB 25MG","15","Select","Select",""],["","51293081001","PHENAZOPYRID ","TAB 100MG","30","Select","Select",""],["","68382000105","PAROXETINE ","TAB 40MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP ","TAB 5-325MG","30","Select","Select",""],["","33342025866","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","64406000602","TECFIDERA ","CAP 240MG","60","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","00054001925","PREDNISONE ","TAB 50MG","75","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","00046087221","PREMARIN ","CRE 0.625MG","30","Select","Select",""],["","60505252703","MODAFINIL ","TAB 200MG","30","Select","Select",""],["","51224001050","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","90","Select","Select",""],["","68382091634","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","90","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","65862022660","CLARITHROMYC ","TAB 500MG","10","Select","Select",""],["","44087400000","MAVENCLAD ","PAK 10MG(10)","10","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","12","Select","Select",""],["","10702010101","METHYLPHENID ","TAB 10MG","60","Select","Select",""],["","00093506001","HYDROXYZ ","TAB 10MG","42","Select","Select",""],["","13668021830","ARIPIPRAZOLE ","10MG","30","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":""}]}]}