{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" MARY  REYNOLDS","gend":1,"add":"1106 VIRGINIA STREET  ","city":"GLASGOW                       ","state":"VA","zip":"24555-2532","dob":"1984-02-19","age":"","mstatus":"","insh":8108869,"cliId":"","pno":"5407845479, 5407845479","cno":"","email":"","ename":"","eno":"","pphy":"SAILER, JAY G                 ","ppno":"               ","pcpadd":"1 Health Cir   ","pcpcity":"Lexington                     ","pcpstate":"VA","pcpzip":244502448,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"VPM4","region":"ROANOKE","aligned":"","ano":"","add2":"","add3":"","madd1":"1106 VIRGINIA STREET     ","madd2":"","madd3":"","mcity":"GLASGOW                       ","mstate":"VA","mzip":"24555-2532","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","J02.9","O12.14","O34.219","D64.9","R31.0","O99.824","O34.211","Z37.0","Z3A.39","O33.9","Z87.891","O99.02","M79.7","R10.2","Z86.59","Z34.90","N28.89","O09.522","O26.832","Z87.59","Z3A.24","D50.0","N28.9","Z87.448","Z34.92","Z23","O09.523","R31.9","Z36.89","Z3A.32","J02.0","Z78.9","N02.9","O09.521","Z3A.11","Z34.83","O80","Z39.1","Z34.82","O09.90","L40.0","L85.3","L57.8","Z79.899","Z11.59","O26.833","O09.293","Z3A.28","M65.842","O99.013","Z3A.38","Z71.89","K86.89","R58","G58.9","K76.0","I83.811","L03.032","L60.0","M79.675","Z32.01","Z20.828","O26.893","O09.529","Z67.91","L90.5","I87.2","Z68.25","M79.674","O36.8391","Z3A.35","R30.0","Z3A.31","O99.019","F11.21","Z3A.36","Z73.3","Z13.89","O12.13","O99.613","O99.713","N02.2","D50.9","Z79.82","K59.00","Z87.11","O99.892","N02.8","Z67.11","R80.9","Z29.8","O23.40","M71.571","M21.6X1","M72.2","L03.031"],"date":["2019-01-21","2019-06-26","2019-04-08","2020-12-22","2021-01-04","2021-02-10","2019-04-08","2021-01-28","2021-01-28","2019-04-09","2019-04-08","2021-01-28","2021-01-28","2021-01-28","2019-04-08","2019-04-08","2020-12-09","2020-08-20","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2021-01-28","2021-03-25","2021-03-25","2019-01-30","2020-12-10","2021-01-28","2020-12-11","2019-02-18","2020-12-22","2019-06-26","2019-06-26","2021-01-28","2020-07-23","2020-07-23","2021-01-04","2021-01-28","2021-02-04","2019-04-15","2021-01-26","2021-05-05","2020-11-04","2021-05-05","2021-05-05","2020-11-04","2021-01-13","2021-01-13","2020-11-24","2020-12-04","2021-01-26","2021-01-28","2019-03-22","2019-05-26","2019-05-26","2019-05-26","2019-05-26","2019-11-27","2020-03-25","2020-03-25","2020-03-25","2020-07-13","2020-09-23","2021-01-28","2020-10-12","2020-10-12","2021-05-05","2019-11-27","2019-11-27","2020-02-26","2020-07-23","2021-01-13","2021-03-25","2020-12-10","2020-12-30","2019-03-20","2019-03-20","2020-02-06","2020-02-06","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2021-01-28","2021-01-28","2021-01-28","2021-01-30","2019-02-18","2019-03-11","2020-02-10","2020-02-10","2020-02-10","2020-02-10"],"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":[["","57894006003","STELARA ","INJ 45MG\/0.5","0.5","Select","Select",""],["","51672127406","BETAMETH ","CRE 0.0005","45","Select","Select",""],["","57896070310","IRON ","TAB 325MG","60","Select","Select",""],["","00185012201","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","00536106210","STOOL ","CAP 100MG","60","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","50222030260","ENSTILAR ","AER ","60","Select","Select",""],["","49483060350","IBUPROFEN ","TAB 600MG","20","Select","Select",""],["","44946104501","PNV ","TAB PLUS","30","Select","Select",""],["","57896020110","PAIN ","TAB 500MG","60","Select","Select",""],["","57896045506","SENNA ","TAB 8.6-50MG","60","Select","Select",""],["","50383026860","CLOBETASOL ","OIN 0.0005","60","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","57237003101","AMOXICILLIN ","CAP 500MG","20","Select","Select",""],["","00536116401","ACETAMIN ","TAB 325MG","100","Select","Select",""],["","16252051501","CIPROFLOXACN ","TAB 500MG","10","Select","Select",""],["","00093005405","BUSPIRONE ","TAB 10MG","20","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","60","Select","Select",""],["","58657015010","FOLIC ","TAB 1MG","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}