{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANNA  M BLACKWELL","gend":1,"add":"101 SYLVA RD APT 29","city":"TAPPAHANNOCK","state":"VA","zip":"22560-9998","dob":"1989-11-01","age":"","mstatus":"","insh":"6426336*01","cliId":"","pno":"804\/617-6546","cno":"804\/617-6546","email":"","ename":"","eno":"","pphy":"TSUI, ALLEN Y MD","ppno":"804\/443-5378","pcpadd":"1362 TAPPAHANNOCK BLVD","pcpcity":"TAPPAHANNOCK","pcpstate":"VA","pcpzip":22560,"pcpcounty":"","pcpid":208062,"pcpname":"TAPPAHANNOCK PRIMARY CARE","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/443-9667","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.31","Z23.","J45.20","R74.8","K76.0","E11.65","J45.40","E66.01","M54.32","J30.9","J32.9","R06.00","Z92.29","Z71.9","J34.2","J34.3","J34.89","Z01.812","Z20.822","G62.9","J44.9","R63.5","Z68.41","G47.30","R04.0","R06.83","M79.7","Z13.220","Z11.59"],"date":["2020-09-22","2020-09-22","2020-09-22","2020-09-22","2021-06-02","2021-06-02","2021-06-02","2020-09-22","2020-09-22","2021-04-27","2021-04-27","2020-09-14","2020-09-14","2020-09-14","2021-04-02","2021-04-02","2021-02-23","2021-03-29","2021-03-29","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2021-03-15","2021-04-09","2020-02-07","2021-06-02","2021-06-02","2021-06-02"],"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":[["","68645056354","IBUPROFEN ","800MG","60","Select","Select",""],["","66993058597","FLUTIC\/SALME ","250\/50","60","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","68180096301","ALBUTEROL ","HFA","8","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","68645058259","METFORMIN ","500MG","180","Select","Select",""],["","67877022210","GABAPENTIN ","100MG","60","Select","Select",""],["","31722099601","HYDROCO\/APAP ","5-325MG","20","Select","Select",""],["","67877021905","CEPHALEXIN ","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}