{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHERINE   M MAINE","gend":1,"add":"4417 DORCHESTER ROAD","city":"NORTON","state":"VA","zip":"24273-4405","dob":"1980-04-24","age":"","mstatus":"","insh":8026140,"cliId":"","pno":2762072605,"cno":2767086346,"email":"","ename":"","eno":"","pphy":"KUMAR, VIJAY","ppno":2763250121,"pcpadd":"610 PARK AVE NW, ","pcpcity":"NORTON","pcpstate":"VA","pcpzip":242730000,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":2767086346,"add2":"                                                            ","add3":"","madd1":"4417 DORCHESTER ROAD","madd2":"                                                            ","madd3":"","mcity":"NORTON","mstate":"VA","mzip":"24273-4405","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.10","F11.20","R68.89","Z47.89","S62.336A","M79.641","Z09","F31.9","R07.89","R06.02","Z79.899","S62.306A","S69.91XA","M79.18","W22.01XA","Y93.9","Y92.9","F41.9","Z11.59","K64.9","J30.9","F31.89","J15.9","J18.9","J96.01","F43.10","Z20.828","F90.9","R00.1","D64.9","H91.90","J45.909","D72.819","M79.7","F17.210","Z86.59","R05","W22.8XXA","Z03.89","R07.9","R11.0","R42","R09.02","S62.636A","E55.9","I10","E11.9","E03.9","E78.5","J45.998","R50.9","R61","R53.83","R09.81","J34.89","J02.9","R53.1","R91.8","R79.1"],"date":["2019-04-25","2019-04-25","2020-05-07","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2021-05-04","2021-04-22","2021-04-22","2019-04-25","2020-05-02","2020-05-02","2020-05-02","2020-05-02","2020-05-02","2020-05-02","2020-05-02","2020-05-06","2020-06-29","2020-06-29","2020-06-29","2020-10-12","2020-10-12","2020-10-14","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2021-04-22","2020-10-12","2020-10-11","2020-05-07","2020-10-11","2021-04-22","2021-04-22","2021-04-22","2020-10-11","2020-05-02","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-10-11","2020-10-11","2020-10-11","2020-10-11","2020-10-11","2020-10-11","2020-10-11","2021-04-22","2021-04-22"],"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":[["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","43547028810","BUPROPION ","TAB 100MG SR","30","Select","Select",""],["","65862022960","LAMOTRIGINE ","TAB 150MG","60","Select","Select",""],["","59651017401","DOXEPIN ","CAP 25MG","30","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","61874011530","VRAYLAR ","CAP 1.5MG","30","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","4","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","51991074790","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","45802043803","HYDROCORT ","CRE 0.01","28","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","60505283303","ATOMOXETINE ","40MG","30","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0.3","Select","Select",""],["","00378064205","PREDNISONE ","20MG","6","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","6","Select","Select",""],["","68180071160","CEFDINIR ","300MG","6","Select","Select",""],["","69097015807","MELOXICAM ","7.5MG","60","Select","Select",""],["","00093770198","LEVOCETIRIZI ","5MG","30","Select","Select",""],["","23155000810","HYDROCHLOROT ","25MG","90","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":""}]}]}