{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TESIA   H STALLARD","gend":1,"add":"1805 DORCHESTER ROAD","city":"NORTON","state":"VA","zip":"24273-4419","dob":"1990-02-02","age":"","mstatus":"","insh":8165182,"cliId":"","pno":2762985333,"cno":2762985333,"email":"","ename":"","eno":"","pphy":"MOORE, RAYMOND MICHAEL","ppno":2766796285,"pcpadd":"280 Virginia Ave NE Ste 101, ","pcpcity":"Norton","pcpstate":"VA","pcpzip":242731539,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1805 DORCHESTER ROAD","madd2":"                                                            ","madd3":"","mcity":"NORTON","mstate":"VA","mzip":"24273-4419","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J20.9","J01.90","R51","F41.9","Z79.899","F41.0","M22.8X1","M25.561","F41.1","F40.01","F31.62","J02.9","E07.9","Z03.818","F32.1","K35.20","L03.113","M79.651","Z03.89","R30.0","R53.83","R10.13","N80.9","R10.9","R11.0","N10","Z87.440","F17.210","Z80.1","Z84.89","E04.9","Z88.1","R10.2","N83.202","G89.29","M25.531","L02.415","Z48.01","Z78.0","N83.9","J02.0","L03.115","B95.62","Z79.2","Z79.891","N94.10","K35.80","R10.30","R53.1","R10.31","R68.83","Z72.0","Z90.49","N76.0","K21.9","R19.00","L03.90","Z23","N39.0","R31.9","E04.2","R07.9","B00.9","N83.209","N80.0"],"date":["2019-04-03","2019-04-03","2019-01-29","2021-01-22","2020-07-21","2021-03-02","2019-04-02","2019-04-03","2020-11-02","2020-01-10","2020-01-23","2020-03-12","2020-11-16","2021-01-04","2019-06-06","2019-09-10","2020-07-24","2020-07-21","2020-07-21","2020-11-15","2021-01-22","2021-01-22","2021-03-18","2019-09-10","2020-03-12","2019-09-10","2020-07-21","2020-07-21","2019-09-10","2019-09-10","2020-07-21","2020-07-21","2021-04-15","2021-02-01","2021-04-15","2021-05-24","2020-07-24","2020-07-24","2021-03-18","2021-03-18","2020-03-12","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2021-02-16","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2020-07-19","2019-09-23","2019-09-23","2020-10-19","2019-02-22","2020-07-19","2020-07-19","2020-11-15","2020-11-15","2020-11-16","2021-01-22","2019-01-09","2019-01-09","2019-02-26"],"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":[["","00093083205","CLONAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","13668013701","ESCITALOPRAM ","TAB 20MG","60","Select","Select",""],["","14539067501","HYDROXYZ ","CAP 50MG","90","Select","Select",""],["","00115165903","PROPRANOLOL ","TAB 10MG","90","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","16729020001","BUSPIRONE ","TAB 5MG","90","Select","Select",""],["","70461031903","FLUCLVX ","INJ 2019-20","0.5","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00093117410","PENICILLN ","TAB 500MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","3","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","15","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","68462018117","CLOTRIMAZOLE ","CRE 0.01","15","Select","Select",""],["","43547030303","ARIPIPRAZOLE ","TAB 5MG","30","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","6","Select","Select",""],["","65162036111","FOLIC ","TAB 1MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","65862044930","VALACYCLOVIR ","TAB 1GM","30","Select","Select",""],["","47781019601","OXYCOD\/APAP ","TAB 5-325MG","12","Select","Select",""],["","65862052890","VENLAFAXINE ","CAP 75MG ER","30","Select","Select",""],["","00143314205","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","51293081101","PHENAZOPYRID ","TAB 200MG","20","Select","Select",""],["","65162047810","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","14","Select","Select",""],["","00143312601","DICYCLOMINE ","CAP 10MG","20","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","",""],["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":""}]}]}