{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DELANEY   M SOAKIE","gend":1,"add":"116 SADDLEBACK RD. ROAD","city":"SALTVILLE","state":"VA","zip":"24370-3409","dob":"2002-09-20","age":"","mstatus":"","insh":7880647,"cliId":"","pno":2762990195,"cno":2762990195,"email":"","ename":"","eno":"","pphy":"HARDEN, AMY J","ppno":2767832511,"pcpadd":"1204 N Main St, ","pcpcity":"Marion","pcpstate":"VA","pcpzip":243544312,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"116 SADDLEBACK RD. ROAD","madd2":"                                                            ","madd3":"","mcity":"SALTVILLE","mstate":"VA","mzip":"24370-3409","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J01.10","R05","J30.9","F32.3","J02.9","R07.9","F33.8","K52.9","R11.2","R42","R19.7","Z79.899","F32.9","F20.9","J45.909","Z87.891","F33.9","R50.9","F41.9","N93.8","N93.9","R10.9","R07.1","X58.XXXA","Y93.9","Y92.9","S23.41XA","S23.429A","Z72.0","F23","F33.3","F17.210","N92.0","A09","N92.6","F33.0","H60.332","Z02.89","H61.22","M54.5","Z23"],"date":["2019-10-22","2019-10-22","2019-10-22","2021-04-21","2019-12-09","2019-05-02","2020-01-06","2020-02-26","2020-02-26","2020-02-26","2020-02-26","2020-02-26","2020-02-26","2020-02-26","2020-02-26","2020-02-26","2020-01-08","2019-02-08","2019-11-06","2020-01-20","2020-01-20","2020-01-20","2019-05-02","2019-05-02","2019-05-02","2019-05-02","2019-05-02","2019-05-02","2019-05-02","2020-01-06","2020-01-08","2020-01-06","2020-01-20","2020-02-26","2020-01-22","2020-01-22","2020-07-15","2020-01-08","2019-02-06","2019-02-08","2020-10-08"],"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":[["","68180035302","SERTRALINE ","TAB 100MG","60","Select","Select",""],["","00378351593","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","00781507701","LORATADINE ","TAB 10MG","30","Select","Select",""],["","62332005471","CLONIDINE ","TAB 0.1MG","30","Select","Select",""],["","00143993905","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","67877057301","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","55111068405","IBU ","TAB 800MG","21","Select","Select",""],["","00065853302","CIPRODEX ","SUS 0.3-0.1%","7.5","Select","Select",""],["","00093585105","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","68180044601","QUETIAPINE ","TAB 50MG","30","Select","Select",""],["","50111043303","TRAZODONE ","TAB 50MG","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","",""],["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":""}]}]}