{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL   S THACKER","gend":0,"add":"719 N ROCKBRIDGE AVENUE","city":"COVINGTON","state":"VA","zip":"24426-1336","dob":"1986-01-15","age":"","mstatus":"","insh":8146628,"cliId":"","pno":5406206124,"cno":5406206124,"email":"","ename":"","eno":"","pphy":"MONROE, JULIE A","ppno":5404633381,"pcpadd":"55 Comfort Way, Ste 1","pcpcity":"Lexington","pcpstate":"VA","pcpzip":244503788,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"719 N ROCKBRIDGE AVENUE","madd2":"                                                            ","madd3":"","mcity":"COVINGTON","mstate":"VA","mzip":"24426-1336","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A41.9","K57.92","N45.1","R65.20","R53.1","E66.9","Z68.38","Z79.899","Z79.2","Z79.82","Z88.4","Z88.1","Z88.8","Z98.890","Z72.0","R10.9","F17.200","K57.32","R10.30","Z68.37","Z71.9","K57.20","R07.9","E80.6","N50.819","K04.7","K08.89","K21.9","R19.7","J02.9","Z71.89","R94.31","N50.811","N50.812","E66.01","R10.0","D72.829","R10.32","S41.112A","W45.0XXA","Y99.0","Z23","B34.9","Z00.00"],"date":["2019-03-17","2019-03-29","2019-03-19","2019-03-17","2019-03-17","2019-03-28","2019-03-17","2019-03-17","2019-03-17","2019-03-17","2019-03-17","2019-03-17","2019-03-17","2019-03-17","2019-03-17","2019-03-25","2021-02-16","2019-03-29","2019-03-26","2019-03-26","2019-03-28","2019-03-29","2021-02-16","2019-03-17","2019-03-18","2020-05-09","2020-05-09","2021-02-16","2021-02-16","2019-02-27","2019-02-27","2021-02-23","2019-03-17","2019-03-17","2019-03-19","2019-03-19","2019-03-19","2019-03-25","2019-04-17","2019-04-17","2019-04-17","2019-04-17","2020-02-19","2021-02-16"],"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":[["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00143928501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","62332002331","FLUOXETINE ","CAP 20MG","90","Select","Select",""],["","69097083412","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","00143122701","DICYCLOMINE ","TAB 20MG","15","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","4","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","15","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","00781185220","AMOX\/K ","TAB 875-125","28","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":""}]}]}