{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CASSIDY REEVES-ZUNIGA","gend":1,"add":"1011 SEVEN OAKS DRIVE","city":"SOUTH BOSTON","state":"VA","zip":"24592-6367","dob":"1999-05-05","age":"","mstatus":"","insh":8188609,"cliId":"","pno":4343491961,"cno":4343491961,"email":"","ename":"","eno":"","pphy":"OZOUDE, VIRGILUS","ppno":4345178022,"pcpadd":"101 Aubreys Loop Ste C, ","pcpcity":"South Boston","pcpstate":"VA","pcpzip":245925054,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"LOT 6","add3":"","madd1":"1011 SEVEN OAKS DRIVE","madd2":"LOT 6","madd3":"","mcity":"SOUTH BOSTON","mstate":"VA","mzip":"24592-6367","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z34.83","Z34.03","R25.3","O80","Z3A.39","Z37.0","S83.402A","R63.5","Z68.35","G43.019","G44.209","G47.00","R25.9","Z13.9","R23.3","F39","E66.9","R10.84","R21","Z72.51","B95.4","R30.0","Z30.40","R39.89","J01.10","M25.562","O90.6","H10.32","B37.3","O70.1","O99.824","Z68.34","N30.01","Z00.00","Z23","Z13.31","B35.3","R11.2","M54.5","J02.9","A08.8","L03.90","Z30.013","Z30.46","Z30.017","Z01.812","Z32.02","N92.1"],"date":["2019-02-01","2019-01-17","2020-01-30","2019-02-06","2019-02-06","2019-02-06","2019-02-14","2019-12-04","2019-11-25","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2019-04-30","2020-07-20","2021-03-08","2020-05-08","2020-10-02","2020-10-02","2020-10-02","2021-03-08","2019-11-04","2020-08-17","2020-08-28","2019-02-22","2019-02-25","2021-03-08","2021-03-08","2019-02-06","2019-02-06","2019-12-04","2020-05-01","2020-07-17","2020-07-17","2020-07-17","2020-07-17","2019-09-09","2019-09-09","2019-09-09","2019-09-09","2019-11-08","2019-11-08","2019-08-29","2019-03-21","2019-03-21","2019-03-21","2019-08-29"],"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":[["","39328010610","PRENATAL ","TAB 27-1MG","30","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","80681013200","VITAMIN ","TAB 50MCG","30","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","4","Select","Select",""],["","45802011222","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","42571016242","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","53746010905","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","00378162001","DICYCLOMINE ","TAB 20MG","30","Select","Select",""],["","76385012450","METHOCARBAM ","TAB 750MG","30","Select","Select",""],["","63868008901","ARTHRTS ","TAB 650MG","30","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","69097012303","TOPIRAMATE ","TAB 50MG","60","Select","Select",""],["","00093321915","KETOCONAZOLE ","CRE 0.02","15","Select","Select",""],["","59762453802","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","16714049601","CLOTRIM\/BETA ","CRE 1-0.05%","15","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","60758090810","POLYMYXIN ","SOL TRIMETHP","10","Select","Select",""],["","49348082110","SM ","TAB 500MCG","30","Select","Select",""],["","42806016005","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","00555901658","SPRINTEC ","TAB 28 DAY","28","Select","Select",""],["","65162019011","NAPROXEN ","TAB 500MG","14","Select","Select",""],["","57237023305","SMZ-TMP ","TAB 800-160","14","Select","Select",""],["","00185012201","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","58657045001","PHENAZOPYRID ","TAB 100MG","6","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","9","Select","Select",""],["","27808006502","PROMETH\/COD ","6.25-10","140","Select","Select",""],["","00093770198","LEVOCETIRIZI ","5MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","65162068090","PROMETHAZINE ","DM","240","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":""}]}]}