{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NERRAWNOSYD ","gend":0,"add":"KCIP 2073ENAL KCIW","city":"HENRICO","state":"VA","zip":"23231-4224","dob":"1960-01-22","age":"","mstatus":"","insh":"40011988","cliId":"","pno":"2240806202","cno":8042220260,"email":"","ename":"","eno":"","pphy":"VCU CENTER FOR ADVANCED HEALTH","ppno":8042543500,"pcpadd":"MCV Physicians, 2116 W Laburnum Ave Ste 100","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232274359,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":8048884627,"add2":"                                                            ","add3":"","madd1":"3702 PICKWICK LANE","madd2":"                                                            ","madd3":"","mcity":"HENRICO","mstate":"VA","mzip":"23231-4224","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I51.7","R10.9","I65.29","K85.90","J44.1","I10","M54.9","M54.2","G89.29","G47.00","F17.200","S82.142A","F10.10","F17.210","E11.40","R41.82","M79.605","E11.9","Z72.0","Z79.84","H52.203","K70.30","F10.99","M62.84","Z86.19","K74.60","Z79.899","I65.23","S82.202A","G89.18","M79.662","S82.102D","J44.9","K86.0","D69.6","Z79.82","R68.89","H90.5","K76.89","K86.89","N20.0","B19.20","I85.00","Z23","H90.2","H90.A32","H93.12","K85.20","R74.8","F10.20","E87.2","R73.9","S82.102A","S82.142D","G40.909","H91.92","L29.9","B18.2","R20.2","H90.3","H61.23","G93.89","I67.82","G31.9","E11.36","H26.9","H35.039","Z01.810","V00.141A","Y92.89","Z79.51","R63.6","Z68.1","R79.9","M50.10","M79.601","R10.13","E87.1","E86.0","E44.0","R00.0","D72.829","R53.1","M25.562","W19.XXXA","Z87.891","A41.9","I65.21","I65.22","B35.9","E11.65","R93.89","V98.8XXA","V00.838A","R27.9","H91.90","K86.1","Q45.3","S82.192A","Z01.818","R56.9","R42","H93.239","R91.8"],"date":["2019-04-08","2019-04-08","2019-10-21","2019-04-23","2019-04-23","2021-04-20","2021-04-15","2019-04-23","2019-04-23","2021-04-15","2019-04-23","2019-08-12","2021-02-23","2021-04-15","2021-04-15","2019-07-03","2019-08-20","2020-09-24","2019-08-20","2021-04-20","2020-02-28","2020-06-23","2020-06-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2019-10-21","2019-06-25","2019-07-03","2019-06-25","2019-08-23","2021-04-15","2019-08-23","2019-08-23","2020-09-24","2020-02-28","2020-08-18","2021-02-23","2020-08-24","2020-08-24","2020-09-24","2020-09-24","2021-04-15","2019-02-06","2019-02-07","2019-02-07","2019-04-10","2019-04-10","2019-04-10","2019-04-10","2019-04-25","2019-06-25","2019-07-03","2019-10-22","2020-02-24","2020-01-15","2020-01-15","2020-01-15","2020-02-26","2020-02-26","2020-06-09","2020-06-09","2020-06-09","2021-04-20","2021-04-20","2021-04-20","2019-06-25","2019-06-25","2019-06-25","2019-06-25","2019-06-25","2019-06-25","2020-01-15","2020-03-02","2020-02-24","2019-04-08","2019-04-08","2019-04-08","2019-04-08","2019-04-08","2019-04-08","2019-07-03","2019-07-03","2019-07-03","2020-02-03","2019-07-03","2019-12-03","2019-12-03","2019-12-03","2019-05-06","2019-05-26","2019-06-24","2019-06-24","2019-07-03","2020-06-09","2019-05-26","2019-05-26","2019-06-24","2019-06-24","2019-11-14","2020-02-26","2020-02-26","2020-06-16"],"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":[["","00193731150","CONTOUR ","TES NEXT","50","Select","Select",""],["","50428029214","CVS ","TAB 100MG","30","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","00536354701","DAILY-VITE ","TAB ","30","Select","Select",""],["","59779046768","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","57664050083","MIRTAZAPINE ","TAB 30MG","30","Select","Select",""],["","50111056001","TRAZODONE ","TAB 50MG","60","Select","Select",""],["","65862052405","GABAPENTIN ","TAB 800MG","90","Select","Select",""],["","71093014005","METHOCARBAM ","TAB 500MG","180","Select","Select",""],["","00186037220","SYMBICORT ","AER 80-4.5","10.2","Select","Select",""],["","10370074601","GLIPIZIDE ","TAB 10MG","60","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","49884093547","DICLOFENAC ","GEL 0.01","200","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","31604001281","VITAMIN ","TAB 100MG","30","Select","Select",""],["","65162036111","FOLIC ","TAB 1MG","30","Select","Select",""],["","79854040050","MULTIVIT-MINERALS ","RAL S TABLET","90","Select","Select",""],["","00093321930","KETOCONAZOLE ","CRE 0.02","30","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","00228212750","CLONIDINE ","TAB 0.1MG","60","Select","Select",""],["","53885000810","ONETOUCH ","MIS PLUS 33G","100","Select","Select",""],["","76385011150","CARVEDILOL ","TAB 6.25MG","60","Select","Select",""],["","00536110888","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","60","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","59779076678","PAIN ","TAB 325MG","60","Select","Select",""],["","80681002000","MULTIVITAMIN ","TAB ","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}