{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ECINAHSREKATIHW S","gend":1,"add":"HKLE 6246DAOR TDRA","city":"RICHMOND","state":"VA","zip":"23225-7823","dob":"1988-12-18","age":"","mstatus":"","insh":"50015421","cliId":"","pno":"9240832213","cno":8042931223,"email":"","ename":"","eno":"","pphy":"ADDIS, DANIEL M","ppno":4347917366,"pcpadd":"219 Parker Rd, ","pcpcity":"Danville","pcpstate":"VA","pcpzip":245404034,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"APT C","add3":"","madd1":"6426 ELKHARDT ROAD","madd2":"APT C","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23225-7823","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","Z30.42","F31.31","F70","J45.901","I10","R68.89","S50.12XA","S50.02XA","F41.9","W18.41XA","E55.9","R45.4","M79.672","W20.8XXA","E11.9","F20.9","F32.9","F39","W18.09XA","E66.9","J45.909","M25.422","R05","R06.2","T78.40XA","M25.522","R73.09","S39.012A","M25.561","V89.2XXA","R50.9","B34.9","N18.9","M47.816","R03.0","F30.9","Z11.3","R06.02","R07.9","R00.0","E66.01","Z00.00","M19.90","S99.922A","M79.632","Z79.899","I51.7","R94.31","R52","S53.402A","Z32.02","B97.81","M11.9","R46.89","F17.200","R06.00","M25.512"],"date":["2021-04-23","2020-09-30","2021-01-06","2021-01-06","2019-10-10","2020-12-30","2020-03-02","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2020-12-30","2019-01-28","2019-08-05","2019-08-05","2020-03-25","2019-08-05","2019-08-05","2019-08-05","2020-06-11","2020-06-11","2020-07-08","2020-06-17","2020-03-01","2019-06-28","2020-04-16","2020-06-17","2020-11-18","2021-05-18","2021-05-18","2021-05-18","2020-03-01","2020-03-01","2020-04-06","2021-05-18","2019-05-23","2019-05-23","2019-10-17","2020-01-29","2020-01-29","2020-03-01","2020-03-25","2020-11-18","2020-12-30","2019-08-05","2020-06-11","2020-06-15","2020-01-29","2020-01-29","2020-03-01","2020-06-17","2020-07-01","2020-10-28","2020-12-02","2019-01-28","2019-06-28","2020-01-29","2020-06-17"],"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":[["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00179830201","CETIRIZINE ","TAB 5MG","30","Select","Select",""],["","67877019805","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","43547034106","RISPERIDONE ","TAB 1MG","30","Select","Select",""],["","43547035610","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","50742061701","METOPROL ","TAB 100MG ER","30","Select","Select",""],["","65162019010","NAPROXEN ","TAB 500MG","60","Select","Select",""],["","62756018388","OXCARBAZEPIN ","TAB 150MG","180","Select","Select",""],["","31722094101","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","65162046510","IBUPROFEN ","TAB 600MG","15","Select","Select",""],["","59762453802","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","29300022701","METRONIDAZOL ","TAB 500MG","4","Select","Select",""],["","16729018201","HYDROCHLOROT ","TAB 12.5MG","30","Select","Select",""],["","68462034690","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","69452014420","BENZONATATE ","CAP 200MG","15","Select","Select",""],["","57896020110","PAIN ","TAB 500MG","112","Select","Select",""],["","58657050016","CODEINE\/GG ","SOL 10-100\/5","100","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","59746017506","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","65862019105","CYCLOBENZAPR ","TAB 10MG","14","Select","Select",""],["","00904672080","ACETAMIN ","TAB 500MG","112","Select","Select",""],["","16571020110","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","42806031250","DOXYCYCL ","100MG","14","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","",""],["No","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":""}]}]}