{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRISTINA   S WOOLWINE","gend":1,"add":"1720 TAYLOR HOLLOW ROAD","city":"BLACKSBURG","state":"VA","zip":"24060-0240","dob":"1979-02-14","age":"","mstatus":"","insh":8146650,"cliId":"","pno":5409511259,"cno":5409511259,"email":"","ename":"","eno":"","pphy":"SUNDARAM, VISHALAKSHI K","ppno":5402651607,"pcpadd":"4910 Valley View Blvd NW Ste 100, ","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240122022,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1720 TAYLOR HOLLOW ROAD","madd2":"                                                            ","madd3":"","mcity":"BLACKSBURG","mstate":"VA","mzip":"24060-0240","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G43.909","F41.9","F41.1","I10","R23.2","M25.511","Z01.89","K62.89","K63.89","K62.5","N92.6","R41.82","T50.901A","Z12.31","T50.911A","Y92.89","G92","Z68.41","F10.20","E66.9","F41.8","R40.2410","J01.00","G43.109","M19.90","J20.9","K60.2","F32.9","M06.9","Z01.419","Z00.00","R63.2","R73.09","R53.82"],"date":["2021-04-14","2020-05-21","2021-04-14","2021-04-14","2020-02-18","2020-02-18","2020-06-01","2019-09-13","2019-09-13","2019-09-13","2020-02-19","2020-06-01","2020-06-01","2021-05-05","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2021-01-13","2020-06-01","2020-06-01","2019-01-07","2019-11-12","2019-11-12","2019-02-12","2019-09-13","2021-04-14","2020-06-16","2020-06-19","2021-04-14","2021-04-14","2021-04-14","2019-05-14"],"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":[["","57237010001","METOPROL ","TAB 25MG","60","Select","Select",""],["","68382031910","TRAMADOL ","TAB 50MG","120","Select","Select",""],["","59762372104","ALPRAZOLAM ","TAB 1MG","90","Select","Select",""],["","69097012215","TOPIRAMATE ","TAB 25MG","30","Select","Select",""],["","00555901658","SPRINTEC ","TAB 28 DAY","28","Select","Select",""],["","42043022209","SUMATRIPTAN ","TAB 100MG","9","Select","Select",""],["","16729044315","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","00254202980","PREVIFEM ","TAB ","28","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","43547028110","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","57237003105","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","65862064163","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","59417010410","VYVANSE ","CAP 40MG","30","Select","Select",""],["","47781049005","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","00143973910","PREDNISONE ","TAB 10MG","21","Select","Select",""],["","68462026290","ROSUVASTATIN ","TAB 10MG","30","Select","Select",""],["","65162047810","NITROFURANTN ","CAP 100MG","20","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","50383070016","FLUTICASONE ","50MCG","16","Select","Select",""],["","63868080224","NASAL ","NT 30MG T","48","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":""}]}]}