{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER FRANCISCO","gend":1,"add":"1230 BRAD SMITH TRAIL","city":"NATHALIE","state":"VA","zip":"24577-2976","dob":"1982-01-19","age":"","mstatus":"","insh":7945911,"cliId":"","pno":4344465609,"cno":4344465609,"email":"","ename":"","eno":"","pphy":"BUCKMAN, PAUL S","ppno":4345178019,"pcpadd":"15210 L P Bailey Memorial Hwy, ","pcpcity":"Nathalie","pcpstate":"VA","pcpzip":245773304,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":4344467144,"add2":"                                                            ","add3":"","madd1":"1230 BRAD SMITH TRAIL","madd2":"                                                            ","madd3":"","mcity":"NATHALIE","mstate":"VA","mzip":"24577-2976","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F44.9","F33.3","F11.94","F33.1","Z03.89","F11.20","F31.4","F19.10","F34.1","F13.20","F60.2","N39.0","R30.0","R31.9","P96.1","Z20.828","F13.21","J03.90","H92.01","F41.1","N91.2","I10","N30.00","M54.5","R41.82","R40.0","R53.81","F17.200","Z88.1","Z88.8","F13.10","O14.15","R10.30","F11.10","R41.0","O42.113","O62.3","Z37.0","Z3A.37","F25.1","Z04.6","Z79.899","O14.14","O99.324","O77.0","O70.1","Z79.891","Z20.822","B34.9","R11.10","R19.7","K76.0","K82.8","O80","F32.0","F41.9","O26.91","R10.84","R11.2","Z3A.00"],"date":["2019-01-30","2020-10-01","2021-03-29","2020-01-15","2019-09-30","2020-09-22","2019-11-01","2020-06-04","2021-03-29","2020-10-05","2021-03-29","2020-09-02","2020-09-02","2020-09-02","2021-02-02","2021-02-15","2021-03-29","2019-05-29","2019-05-29","2019-12-11","2020-08-05","2021-03-31","2020-01-27","2020-01-27","2020-05-12","2020-05-12","2020-05-12","2020-09-28","2020-05-12","2020-05-12","2020-09-28","2021-02-04","2020-01-19","2021-02-01","2020-05-19","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2019-01-31","2019-01-31","2019-01-31","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2020-04-13","2020-04-13","2020-04-13","2020-06-06","2020-06-06","2021-02-01","2019-03-25","2019-03-25","2020-06-06","2020-06-06","2020-06-06","2020-06-06"],"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":[["","13107000130","MIRTAZAPINE ","TAB 7.5MG","30","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","65862019301","FLUOXETINE ","CAP 20MG","90","Select","Select",""],["","75826011510","PHENAZOPYRID ","TAB 200MG","6","Select","Select",""],["","23155007001","METHIMAZOLE ","TAB 5MG","30","Select","Select",""],["","00093816201","QUETIAPINE ","TAB 100MG","30","Select","Select",""],["","13107015690","PAROXETINE ","TAB 30MG","60","Select","Select",""],["","68382004001","PROMETHAZINE ","TAB 12.5MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","66993068530","OLANZAPINE ","TAB 20MG","30","Select","Select",""],["","59746036190","VALSARTAN ","TAB 80MG","30","Select","Select",""],["","13925011701","SE-NATAL ","CHW ","90","Select","Select",""],["","70710122901","AMITRIPTYLIN ","TAB 100MG","30","Select","Select",""],["","00904615760","VITAMIN ","TAB 2000UNIT","60","Select","Select",""],["","00093506201","HYDROXYZ ","TAB 50MG","90","Select","Select",""],["","41167000609","UNISOM ","TAB 25MG","60","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","60","Select","Select",""],["","00832154011","HALOPERIDOL ","TAB 5MG","30","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","24385044164","SLEEP ","TAB 25MG","30","Select","Select",""],["","23155000101","HYDRALAZINE ","TAB 10MG","240","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","40","Select","Select",""],["","00093081201","NORTRIPTYLIN ","CAP 50MG","30","Select","Select",""],["","65862070460","ZIPRASIDONE ","CAP 60MG","30","Select","Select",""],["","50742026001","NIFEDIPINE ","TAB 30MG ER","60","Select","Select",""],["","00228212810","CLONIDINE ","TAB 0.2MG","30","Select","Select",""],["","71093014105","METHOCARBAM ","TAB 750MG","30","Select","Select",""],["","69842054447","ARTHRTS ","TAB 650MG","30","Select","Select",""],["","50428488021","STOOL ","CAP 100MG","60","Select","Select",""],["","69238105801","CHLORPROMAZ ","TAB 50MG","30","Select","Select",""],["","50428014677","CVS ","CAP 2000UNIT","42","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","00135019402","NICODERM ","DIS 21MG\/24H","14","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","59779044101","SLEEP-AID ","TAB 25MG","30","Select","Select",""],["","00536110788","NICOTINE ","DIS 14MG\/24H","28","Select","Select",""],["","00143122701","DICYCLOMINE ","TAB 20MG","18","Select","Select",""],["","00054001829","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","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":""}]}]}