{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WENDI   N TOOMBS","gend":1,"add":"2008 CIRCLE STONE CT","city":"COLONIAL HEIGHTS","state":"VA","zip":"23834-9998","dob":"1985-10-04","age":"","mstatus":"","insh":"6110177*01","cliId":"","pno":"804\/892-9887","cno":"804\/892-9887","email":"","ename":"","eno":"","pphy":"ARMSTRONG, BRENT MD","ppno":"804\/458-8557","pcpadd":"815 W POYTHRESS ST","pcpcity":"HOPEWELL","pcpstate":"VA","pcpzip":23860,"pcpcounty":"","pcpid":164601,"pcpname":"Appomattox River Medical, LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/541-7113","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J02.9","D64.89","F33.9","S93.491A","S99.911A","M79.89"],"date":["2020-05-18","2020-05-18","2020-05-18","2020-09-21","2021-10-21","2021-10-21"],"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":[["","70710122700","AMITRIPTYLIN ","50MG","30","Select","Select",""],["","00378623101","CITALOPRAM ","10MG","30","Select","Select",""],["","49884072703","DOXYCYC ","100MG","20","Select","Select",""],["","68462019005","NAPROXEN ","500MG","10","Select","Select",""],["","64380071306","BENZONATATE ","200MG","30","Select","Select",""],["","70710122700","AMITRIPTYLIN","50MG","30","Select","Select",""],["","00378623101","CITALOPRAM","10MG","30","Select","Select",""],["","49884072703","DOXYCYC","100MG","20","Select","Select",""],["","64380071306","BENZONATATE","200MG","30","Select","Select",""],["","68462019005","NAPROXEN","500MG","10","Select","Select",""],["","00093005401","BUSPIRONE","10MG","90","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","15","Select","Select",""],["","00093005401","BUSPIRONE ","TAB 10MG","90","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":""}]}]}