{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAYLA   M BRINEGAR","gend":1,"add":"233 MADDUX FARM DRIVE","city":"GATE CITY","state":"VA","zip":"24251-4213","dob":"1984-08-19","age":"","mstatus":"","insh":8210264,"cliId":"","pno":2762092161,"cno":2762092161,"email":"","ename":"","eno":"","pphy":"BLACK, PAUL CLIFFORD","ppno":7575362246,"pcpadd":"390 Kane St, ","pcpcity":"Gate City","pcpstate":"VA","pcpzip":242512753,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"233 MADDUX FARM DRIVE","madd2":"                                                            ","madd3":"","mcity":"GATE CITY","mstate":"VA","mzip":"24251-4213","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","D50.8","I10","E03.9","I07.1","F43.10","F32.1","F11.21","Z79.899","L03.115","Z23","F33.1","I36.1","R06.02","Z86.79","Z13.220","L97.222","M79.604","I83.893","Z02.83","R06.2","R06.00","I87.2","R07.9","R00.0","S61.432A","W22.8XXA","I38","R00.2","F19.10","Z68.31","L25.5","I25.10","Z72.0","I34.0","I33.0","I50.9","Z80.49","L97.929","I83.812","I87.323","R07.89","R53.1","N30.00","R61","I83.811","R06.09","M79.605","J44.9","B19.20","Z76.0","E07.9","F17.210","R60.0"],"date":["2019-03-19","2020-07-23","2020-07-23","2020-12-03","2020-07-23","2021-01-22","2021-01-22","2021-01-22","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2020-07-23","2020-03-12","2019-06-27","2019-06-27","2019-06-27","2020-08-19","2019-08-08","2019-08-08","2020-02-21","2020-02-21","2020-08-19","2020-08-19","2020-08-19","2020-08-19","2019-06-27","2020-02-21","2020-02-21","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2019-04-26","2019-05-23","2019-08-08","2019-08-08","2019-08-08","2019-08-08","2019-04-10","2019-11-15","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2019-08-08","2019-08-08","2019-11-19"],"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":[["","43547029010","BUPROPION ","TAB 200MG SR","60","Select","Select",""],["","00173086910","ANORO ","AER 62.5-25","60","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00378180310","LEVOTHYROXIN ","TAB 50MCG","30","Select","Select",""],["","67877022305","GABAPENTIN ","CAP 300MG","120","Select","Select",""],["","69315011610","FUROSEMIDE ","TAB 20MG","60","Select","Select",""],["","00378001805","METOPROL ","TAB 25MG","30","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","68180032006","BUPROPN ","TAB 300MG XL","30","Select","Select",""],["","51862058505","LORCET ","TAB 5-325MG","18","Select","Select",""],["","51672131200","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","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":[[["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":""}]}]}