{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TS NNAOJSREHTOR","gend":1,"add":"AM E 1072TEERTS NI","city":"RICHMOND","state":"VA","zip":"23223-7964","dob":"1957-12-30","age":"","mstatus":"","insh":"50014480","cliId":"","pno":"4471993912","cno":9174421939,"email":"","ename":"","eno":"","pphy":"CARTER, RENEE Y","ppno":8045608921,"pcpadd":"201 N Hamilton St, ","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232212601,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":8042761445,"add2":"APT 407","add3":"","madd1":"2701 E MAIN STREET","madd2":"APT 407","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23223-7964","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.16","G89.4","M79.605","E11.9","N39.3","M54.9","Z79.899","M43.16","M51.27","R68.89","Z12.31","M54.5","R05","J06.9","B20","E78.5","I10","Z79.84","Z23","M79.609","M51.16","E66.9","J31.0","I83.93","Z68.33","M43.17","H40.033","H25.13","M79.606","M54.17","M79.604","R51.9","J32.9","J45.909","Z87.891","M79.662","M79.671","Z71.3","Z01.411","Z21","Z01.419","N72","R87.619","R32","R79.89","H66.91","R09.81","M19.90","G47.00","Z68.34","M47.26","H66.93"],"date":["2020-06-12","2019-04-11","2019-05-24","2021-03-16","2019-09-03","2020-12-23","2021-03-16","2020-06-12","2019-11-12","2020-12-23","2020-11-11","2020-12-23","2019-03-14","2019-03-14","2020-10-07","2020-10-07","2020-10-24","2021-03-16","2019-10-15","2019-05-24","2019-08-27","2021-03-16","2019-06-11","2019-06-11","2019-06-11","2019-08-27","2019-12-19","2019-12-19","2020-09-29","2020-09-29","2021-05-20","2020-10-24","2020-10-24","2021-03-16","2021-03-16","2019-05-21","2019-05-21","2019-05-21","2019-07-25","2019-07-25","2019-07-25","2019-07-25","2019-07-25","2019-09-03","2020-10-07","2019-10-27","2019-10-27","2019-10-27","2020-03-06","2020-03-06","2019-09-19","2019-10-27"],"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":[["","49702023113","TRIUMEQ ","TAB ","30","Select","Select",""],["","70377000712","ROSUVASTATIN ","TAB 10MG","30","Select","Select",""],["","68382076010","METFORMIN ","TAB 1000MG","30","Select","Select",""],["","67877057505","BENZONATATE ","CAP 200MG","60","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","1","Select","Select",""],["","00186037220","SYMBICORT ","AER 80-4.5","10.2","Select","Select",""],["","00093742698","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","00115166103","PROPRANOLOL ","TAB 40MG","60","Select","Select",""],["","55111029336","SUMATRIPTAN ","TAB 100MG","9","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","69097012203","TOPIRAMATE ","TAB 25MG","60","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","70461032003","FLUCLVX ","INJ 2020-21","0.5","Select","Select",""],["","00169406012","VICTOZA ","INJ 18MG\/3ML","6","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","00378967130","IPRATROPIUM\/ ","SOL ALBUTER","90","Select","Select",""],["","00597002402","COMBIVENT ","AER 20-100","4","Select","Select",""],["","00591544310","PREDNISONE ","TAB 20MG","18","Select","Select",""],["","00904673080","ACETAMIN ","TAB 500MG","30","Select","Select",""],["","66993066260","DULOXETINE ","CAP 20MG","60","Select","Select",""],["","68180016106","AZITHROMYCIN ","TAB 500MG","5","Select","Select",""],["","61442011201","ACYCLOVIR ","TAB 400MG","30","Select","Select",""],["","10702001250","HYDROXYZ ","TAB 50MG","30","Select","Select",""],["","51991081403","AZELASTINE ","SPR 0.001","30","Select","Select",""],["","59779061275","ALLERGY ","TAB 10MG","90","Select","Select",""],["","10702025350","BUT\/APAP\/CAF ","TAB ","14","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","51672128901","NYSTATIN ","CRE 100000","30","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","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","",""],["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":""}]}]}