{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARTHA   J COMBS","gend":1,"add":"74 IVY RIDGE ROAD","city":"CLEVELAND","state":"VA","zip":"24225-2636","dob":"1973-08-31","age":"","mstatus":"","insh":7937144,"cliId":"","pno":2768893885,"cno":2768893885,"email":"","ename":"","eno":"","pphy":"HARMAN, NICHOLAS","ppno":2768893700,"pcpadd":"495 E Main St, ","pcpcity":"Lebanon","pcpstate":"VA","pcpzip":242664617,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"74 IVY RIDGE ROAD","madd2":"                                                            ","madd3":"","mcity":"CLEVELAND","mstate":"VA","mzip":"24225-2636","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H43.393","J30.89","J30.1","J30.81","K29.70","F45.8","D50.9","K44.9","K31.9","R19.5","R10.30","R19.7","K57.00","K21.9","I10","D50.8","J45.30","J98.11","J90","J45.909","E66.9","Z68.35","D64.9","R00.0","R10.84","S52.122D","M25.522","M25.512","E78.2","K21.0","K22.2","K57.32","N28.1","K76.89","K57.33","R10.31","R11.0","Z87.442","K58.9","Z79.899","Z90.710","H11.30","R19.4","K57.30","Z01.811","K44.0","Z48.815","J43.9","R10.9","N89.8","Z12.31","R30.0","N95.0","Z01.810","Z01.818","Z01.812","I25.2","R79.89","R13.10","R63.3","M79.602","S52.125A","Z92.89"],"date":["2021-02-04","2021-05-17","2021-05-17","2019-10-31","2019-06-11","2019-06-11","2020-01-10","2019-12-03","2019-06-11","2019-06-19","2020-01-10","2019-06-19","2019-06-19","2019-11-21","2021-04-14","2019-11-12","2019-11-12","2019-11-25","2019-11-21","2019-11-21","2019-11-21","2019-11-21","2019-11-21","2019-11-21","2019-11-24","2020-10-29","2020-10-29","2020-10-29","2021-04-14","2020-01-10","2019-06-11","2019-09-13","2019-09-13","2019-09-13","2019-09-13","2019-09-13","2019-09-13","2019-09-13","2019-09-13","2019-09-13","2019-09-13","2021-01-13","2019-06-19","2019-06-19","2019-11-08","2019-11-21","2019-11-21","2019-11-21","2020-01-10","2019-04-17","2020-09-23","2019-02-13","2019-04-17","2019-11-08","2019-11-08","2019-11-08","2019-11-08","2019-11-08","2019-11-22","2019-11-22","2020-05-26","2020-05-26","2020-08-04"],"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":[["","67877019810","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","42571016201","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","31722094101","HYDROCO\/APAP ","TAB 5-325MG","6","Select","Select",""],["","55111015905","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","45802011859","MOMETASONE ","SOL 0.001","30","Select","Select",""],["","00574060811","FERROUS ","TAB 324MG EC","60","Select","Select",""],["","33332031901","AFLURIA ","INJ 2019-20","0.5","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","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":""}]}]}