{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONALD   B JACKSON JR","gend":0,"add":"2 MILTON AVENUE","city":"DANVILLE","state":"VA","zip":"24541-4823","dob":"1978-09-21","age":"","mstatus":"","insh":8090629,"cliId":"","pno":4347106903,"cno":4347106903,"email":"","ename":"","eno":"","pphy":"STEPHENS, AMBER","ppno":4347925964,"pcpadd":"2767 Franklin Tpke, ","pcpcity":"Danville","pcpstate":"VA","pcpzip":245405273,"pcpcounty":"","pcpid":"","pcpname":"SOVAH SURGICAL SPECIALISTS","ano":"","add2":"                                                            ","add3":"","madd1":"2 MILTON AVENUE","madd2":"                                                            ","madd3":"","mcity":"DANVILLE","mstate":"VA","mzip":"24541-4823","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.43","E78.5","I10","E11.9","E11.622","L97.812","E11.40","F17.290","M19.90","Z79.4","Z79.899","Z83.3","L92.1","I87.311","I87.2","L03.031","E78.00","L97.822","T24.002A","E11.51","R23.1","E11.628","T31.10","L97.829","E11.65","R11.0","M62.830","M54.9","F17.210","R11.2","R51.9","D50.9","E11.42","Z91.19","R10.31","Z91.5","E11.00","N18.9","I87.8","L97.819","I83.892","E11.621","L97.519","Z72.0","T24.202A","M54.5","R19.7","E08.65","R55","R07.9","R06.09","M79.606","Z09","T24.202D","E55.9","S81.811D","T24.302D","E78.2","N28.9","R31.9","S80.812A","X58.XXXA","Y92.9","Y99.9","F41.8","R73.9","W01.0XXA","I83.891","I83.811","Z98.890","M79.89","E86.0","G62.9","R23.8","E11.3393","K52.9","E11.610","R50.9","M79.10"],"date":["2020-05-12","2021-04-09","2021-04-27","2021-04-27","2019-06-14","2019-06-14","2020-04-17","2021-04-09","2020-04-17","2021-04-27","2021-04-09","2020-04-17","2019-05-09","2020-04-20","2019-08-22","2019-09-12","2021-04-27","2020-04-17","2020-02-07","2020-05-12","2020-02-07","2020-02-11","2020-02-11","2020-02-11","2021-04-27","2020-05-12","2020-06-09","2021-04-09","2020-06-09","2021-04-10","2021-04-09","2021-04-09","2021-04-09","2021-04-09","2021-04-09","2021-04-09","2021-04-10","2021-04-10","2019-06-21","2019-06-21","2019-08-22","2019-09-12","2019-09-12","2021-04-27","2020-01-30","2020-08-11","2019-02-20","2019-02-20","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2020-08-13","2020-02-14","2020-03-06","2019-05-31","2020-04-17","2021-04-27","2020-08-13","2020-08-13","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2019-07-09","2019-07-09","2019-07-12","2019-09-10","2020-02-05","2019-05-07","2019-05-07","2021-04-26","2019-02-20","2019-09-12","2020-02-05","2020-02-05"],"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":[["","00169633910","NOVOLOG ","INJ FLEXPEN","15","Select","Select",""],["","31722070010","LOSARTAN ","TAB 25MG","90","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","48","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","60505258008","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","10","Select","Select",""],["","43547035211","LISINOPRIL ","TAB 5MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR ","TAB 10MG","14","Select","Select",""],["","57664037718","TRAMADOL ","TAB 50MG","15","Select","Select",""],["","68382076010","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","70010075405","METHOCARBAM ","TAB 500MG","40","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","86227012155","SURE ","MIS 31GX5\/16","400","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","57237023305","SMZ-TMP ","TAB 800-160","10","Select","Select",""],["","00527169505","BUT\/APAP\/CAF ","TAB ","5","Select","Select",""],["","00591079510","DICYCLOMINE ","TAB 20MG","20","Select","Select",""],["","42571025201","CLINDAMYCIN ","CAP 300MG","40","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","24658031205","DOXYCYCL ","TAB 100MG","10","Select","Select",""],["","68180035103","SERTRALINE ","25MG","90","Select","Select",""],["","00002143301","TRULICITY ","0.75\/0.5","2","Select","Select",""],["","10135011901","PYRIDOXINE ","25MG","90","Select","Select",""],["","73070010315","INSULIN ","FLEXPEN","15","Select","Select",""],["","08222095855","PEN  NEEDLES  ","31GX8MM","200","Select","Select",""],["","00536589488","NICOTINE ","7MG\/24HR","28","Select","Select",""],["","69238131109","PREGABALIN ","50MG","60","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":""}]}]}