{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRANDON   T FLEMING","gend":0,"add":"5835 CRANES NEST ROAD","city":"COEBURN","state":"VA","zip":"24230-5209","dob":"1986-10-08","age":"","mstatus":"","insh":8019352,"cliId":"","pno":2768077015,"cno":2768077015,"email":"","ename":"","eno":"","pphy":"BENTLEY, JODY B","ppno":2763288910,"pcpadd":"716 Spring Ave SE Ste 103, ","pcpcity":"Wise","pcpstate":"VA","pcpzip":242935702,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"5835 Cranes Nest Rd","madd2":"                                                            ","madd3":"","mcity":"Coeburn","mstate":"VA","mzip":"24230-5209","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.2","Z13.29","N20.0","R10.9","N20.2","D72.829","F11.20","S06.9X6A","Z79.899","R68.89","R41.841","F17.200","S06.9X6D","Z13.220","G43.909","F41.0","I10","R07.89","N20.1","R64","F19.90","R31.9","F17.210","Z68.20","Z87.442","N13.2","R10.31","N17.9","F19.10","E11.10","R82.5","M47.12","G25.81","F17.290","F11.10","R11.2","N13.30","Z72.0","M19.90","E87.6","Z99.3","Z01.818","Z20.822","F41.9","F32.9","S06.9X0S","S01.90XS"],"date":["2019-02-20","2019-02-20","2019-03-24","2019-03-23","2019-03-23","2019-03-23","2019-12-30","2020-11-24","2019-12-11","2019-12-30","2021-01-20","2021-05-10","2021-05-10","2021-05-10","2019-02-20","2019-02-20","2019-03-23","2019-03-22","2019-03-24","2019-03-22","2019-03-22","2019-03-22","2021-01-01","2019-03-22","2021-01-01","2019-03-23","2019-03-23","2019-03-24","2019-03-23","2019-03-23","2019-03-23","2019-01-22","2019-01-22","2019-01-22","2019-03-23","2019-03-23","2019-03-24","2019-03-24","2021-01-01","2021-01-01","2020-11-01","2021-01-14","2021-01-14","2021-01-01","2021-01-01","2021-01-20","2021-01-20"],"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":[["","60505025202","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","00223041158","ALLEVYN ","PAD 9\"X9\"","10","Select","Select",""],["","13668001005","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","68462013801","OXCARBAZEPIN ","TAB 300MG","60","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","9","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","10","Select","Select",""],["","68001028103","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","00185061505","HYDROXYZ ","CAP 50MG","120","Select","Select",""],["","00527133001","BACLOFEN ","TAB 10MG","56","Select","Select",""],["","68382013814","TOPIRAMATE ","TAB 25MG","120","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","40","Select","Select",""],["","68001033408","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","00406012401","HYDROCO\/APAP ","TAB 7.5-325","90","Select","Select",""],["","00904645760","DOK ","CAP 100MG","30","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","33342002715","DONEPEZIL ","TAB 5MG","30","Select","Select",""],["","16714033002","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","69618004901","SENNA ","TAB 8.6-50MG","30","Select","Select",""],["","68001032205","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","64980030130","PROCTOZONE ","CRE -HC 2.5%","30","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","00904699880","DOCUSATE ","100MG","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}