{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VICTORIA  C FOUTS","gend":1,"add":"221 SULGRAVE AVE","city":"PETERSBURG","state":"VA","zip":"23805-9998","dob":"1998-11-20","age":"","mstatus":"","insh":"6435912*01","cliId":"","pno":8042554851,"cno":8042554851,"email":"","ename":"","eno":"","pphy":"ARMSTRONG, BRENT MD","ppno":8045201110,"pcpadd":"3512 BOULEVARD","pcpcity":"COLONIAL HEIGHTS","pcpstate":"VA","pcpzip":"23834-9998","pcpcounty":"","pcpid":"","pcpname":"Appomattox River Primary Care, LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8045263105,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","Z20.828","E53.8","E55.9","K21.9","E78.5","Z23.","M79.632","M25.512","I49.8","Z01.419","Z11.51","Z30.09","R55.","I37.1","R07.89","S05.02XA","H57.02","R00.0","S54.92XA","R00.2","G90.1","Z30.46","Z30.41","R94.31","Z03.818","Z20.822","U07.1","R05."],"date":["2021-12-04","2021-12-04","2023-04-21","2023-04-21","2023-04-21","2023-04-21","2022-11-15","2021-07-01","2021-11-22","2021-11-22","2022-03-29","2022-03-29","2022-03-29","2022-05-11","2022-05-11","2022-05-11","2022-03-07","2022-03-15","2022-05-11","2021-07-16","2022-07-01","2022-07-01","2021-06-22","2021-06-22","2021-11-05","2021-11-18","2021-11-18","2021-08-24","2021-08-24"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00378729653","DESO\/ETHINYL","TAB ESTRADIO","28","Select","Select",""],["","16714036004","MONO-LINYAH","TAB 0.25-35","28","Select","Select",""],["","70700012285","VOLNEA","TAB ","28","Select","Select",""],["","00126007061","PREVDNT 5000","GEL 1.1-5%","100","Select","Select",""],["","00143962125","CYANOCOBALAM","INJ 1000MCG","1","Select","Select",""],["","64380073706","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","8","Select","Select",""],["","68462039610","OMEPRAZOLE","20 MG","30","Select","Select",""],["","68180089173","ENSKYCE","0.15-0.03","84","Select","Select",""],["","17478007035","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","00223176001","SOD CHLORIDE","TAB 1GM","30","Select","Select",""],["","08290309581","3ML LL SYRNG","MIS 25GX1\"","1","Select","Select",""],["","87701040731","VITAMIN B-","12 500 MCG","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}