{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAUREN   A POWERS","gend":1,"add":"P.O. BOX 836","city":"MINERAL","state":"VA","zip":"23117-0836","dob":"1993-10-07","age":"","mstatus":"","insh":7890709,"cliId":"","pno":5406039347,"cno":5406039347,"email":"","ename":"","eno":"","pphy":"COOK, JAMES S","ppno":8047629646,"pcpadd":"2105 E Parham Rd Ste 109, ","pcpcity":"Henrico","pcpstate":"VA","pcpzip":232282236,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"P.O. BOX 836","madd2":"                                                            ","madd3":"","mcity":"MINERAL","mstate":"VA","mzip":"23117-0836","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L50.9","R10.9","O14.02","O09.292","O34.219","Z3A.25","O76","Z3A.27","Z37.0","Z39.2","N30.00","R05","Z20.828","R03.0","N13.2","M54.9","R11.0","N39.0","N83.201","Z88.1","Z88.2","Z88.5","O99.89","R32","Z3A.15","O09.299","Z34.81","Z3A.17","O26.892","R12","O99.212","E66.01","R93.9","Z3A.20","O34.211","Z3A.24","Z3A.26","O28.8","O36.8120","O11.2","O10.912","O33.7XX0","O35.0XX0","O32.1XX0","Z30.2","N20.2","N83.01","P96.89","R18.8","J02.9","Z36.3","M54.5","O09.291","Z3A.13","O10.919","Z34.82","O14.92","Z98.891","O36.5920","O14.94","O99.344","F32.9","O99.62","K21.9","Z3A.28","Z23","R59.1","Z36.87","Z3A.09","R21","H66.001","O11.9","R52","M54.89","R09.02","J20.9","I10","O11.4","O10.92","O75.4","K66.0","Z98.890","Z09","Z91.89"],"date":["2019-07-02","2020-08-05","2019-09-25","2019-10-02","2019-10-02","2019-09-18","2019-10-04","2019-10-04","2019-10-04","2019-11-20","2019-12-02","2020-05-12","2020-05-12","2020-05-12","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2019-07-05","2019-07-05","2019-07-05","2019-09-25","2019-09-25","2019-07-23","2019-08-06","2019-07-23","2019-08-14","2020-09-03","2019-08-14","2019-09-10","2019-10-04","2019-09-10","2019-09-25","2019-10-02","2019-10-02","2019-10-03","2019-10-03","2019-10-04","2019-10-04","2019-10-04","2019-10-04","2020-08-05","2020-08-05","2019-10-03","2019-10-03","2020-07-24","2019-09-10","2020-08-05","2019-06-25","2019-06-25","2019-10-09","2019-09-10","2019-09-25","2019-10-09","2019-09-10","2019-10-02","2019-10-02","2019-10-02","2019-10-02","2019-10-02","2019-10-02","2019-10-02","2020-07-24","2019-06-03","2019-06-03","2019-07-02","2019-09-05","2019-09-25","2020-08-05","2020-08-05","2020-08-05","2020-08-10","2020-09-17","2019-10-04","2019-10-04","2019-10-04","2019-10-04","2019-10-09","2019-10-09","2020-07-30"],"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":[["","63044015001","PRENATAL ","TAB LOW IRON","30","Select","Select",""],["","00093220305","METOCLOPRAM ","TAB 10MG","20","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","14","Select","Select",""],["","68382097001","CHLORTHALID ","TAB 25MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","20","Select","Select",""],["","65862020299","LOSARTAN ","TAB 50MG","30","Select","Select",""],["","00536440801","VITAMIN ","TAB 50MG","60","Select","Select",""],["","00054001925","PREDNISONE ","TAB 50MG","5","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","67877057505","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","69367016204","PHENAZOPYRID ","TAB 100MG","10","Select","Select",""],["","00904671980","ACETAMINOPHEN ","TA B 325","120","Select","Select",""],["","50742062001","NIFEDIPINE ","TAB 30MG ER","30","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","6","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","90","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","30","Select","Select",""],["","00904530660","BANOPHEN ","CAP 25MG","24","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","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":""}]}]}