{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" G YMMAT DRAZZILB","gend":1,"add":"DIRB S 832TEERTS EG","city":"BEDFORD","state":"VA","zip":"24523-2740","dob":"1964-09-30","age":"","mstatus":"","insh":"50018734","cliId":"","pno":",69274020459431125045 ","cno":"","email":"","ename":"","eno":"","pphy":"BLANKS, VIRGINIA L","ppno":5402977181,"pcpadd":"4830 Rucker Rd, ","pcpcity":"Moneta","pcpstate":"VA","pcpzip":241215281,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE","aligned":"","ano":"","add2":"APARTMENT B","add3":"","madd1":"238 S BRIDGE STREET","madd2":"APARTMENT B","madd3":"","mcity":"BEDFORD","mstate":"VA","mzip":"24523-2740","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.3","B35.1","M79.674","M79.675","R39.81","N39.46","F33.1","A41.9","W01.0XXA","N39.0","B96.20","Z11.59","E66.01","Z68.43","E11.22","I12.9","N18.3","S93.402A","S80.211A","I89.0","G47.30","F17.210","I10","E66.2","F31.9","K59.00","Z91.19","F41.9","Z79.899","R62.7","F31.62","E11.8","E11.9","G47.33","R32","R39.15","B02.9","R23.8","L85.3","Z72.0","N39.3","L21.9","Z59.8","F32.3","Z59.1","R68.89","L97.919","Z87.440","Z79.4","N18.30","S31.809A","R35.0","E16.1","E16.2","E11.65","T68.XXXA","R58","R53.1","L30.9","R09.02","R30.0","B96.89","S99.912A","S89.92XA","M17.12","S89.91XA","M17.11","S99.911A","N30.00","R59.0","N20.0","Z90.49","R26.2","Z88.1","Z88.8","Z02.2","R09.89","I51.7"],"date":["2019-09-28","2019-07-02","2019-07-02","2019-07-02","2021-04-24","2021-04-24","2020-04-09","2020-05-22","2020-05-20","2021-05-14","2020-09-06","2020-05-20","2021-05-14","2020-10-15","2021-05-14","2021-05-08","2020-09-30","2020-05-28","2020-05-20","2021-05-11","2020-09-06","2021-05-08","2021-05-11","2020-09-06","2021-05-14","2020-09-21","2021-05-11","2020-09-09","2021-05-08","2021-05-14","2021-04-29","2021-03-10","2021-05-11","2021-05-11","2019-03-14","2019-03-14","2019-03-14","2019-03-14","2019-03-14","2021-04-16","2019-08-22","2019-08-22","2019-08-22","2019-08-22","2021-04-16","2019-11-07","2020-07-01","2020-10-15","2020-10-15","2021-05-08","2021-05-11","2019-01-05","2020-05-20","2020-05-20","2020-05-28","2020-05-20","2021-05-08","2020-09-09","2020-09-09","2021-05-08","2021-05-08","2020-09-06","2020-05-20","2020-05-20","2020-05-20","2020-05-20","2020-05-20","2020-05-20","2020-05-28","2020-05-20","2020-05-20","2020-05-20","2020-05-28","2020-09-06","2020-09-06","2020-09-08","2021-05-11","2021-05-11"],"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":[["","00781519092","LEVOTHYROXIN ","TAB 300MCG","30","Select","Select",""],["","00185061501","HYDROXYZ ","CAP 50MG","60","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","24","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","67877022310","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","63402030230","LATUDA ","TAB 20MG","30","Select","Select",""],["","00093585105","ESCITALOPRAM ","TAB 10MG","90","Select","Select",""],["","08290326895","BD ","PAD SNGL USE","200","Select","Select",""],["","16571040250","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","16714068403","SIMVASTATIN ","TAB 40MG","30","Select","Select",""],["","51248015101","VESICARE ","TAB 10MG","30","Select","Select",""],["","31722070290","LOSARTAN ","TAB 100MG","30","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","00093727156","PIOGLITAZONE ","TAB 15MG","30","Select","Select",""],["","00093031101","LOPERAMIDE ","CAP 2MG","100","Select","Select",""],["","51862032101","LIOTHYRONINE ","TAB 25MCG","30","Select","Select",""],["","50111056001","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","00603548221","PROPRANOLOL ","TAB 10MG","60","Select","Select",""],["","00002822259","INSULIN ","INJ 100\/ML","3","Select","Select",""],["","78742049911","FOLIC ","TAB 400MCG","30","Select","Select",""],["","67877052830","SOLIFENACIN ","TAB 10MG","30","Select","Select",""],["","00555088602","ESTRADIOL ","TAB 1MG","30","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","50580036702","IMODIUM ","MG SOFTGEL","100","Select","Select",""],["","00093100301","BUSPIRONE ","TAB 15MG","120","Select","Select",""],["","45802088094","NYSTAT\/TRIAM ","CRE ","60","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","00069046856","CHANTIX ","TAB 0.5MG","56","Select","Select",""],["","45802006435","TRIAMCINOLON ","CRE 0.001","60","Select","Select",""],["","57237007810","ONDANSETRON ","TAB 8MG ODT","15","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","15","Select","Select",""],["","00185012201","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","49884046565","CHOLESTYRAM ","POW 4GM","30","Select","Select",""],["","59746032530","VALACYCLOVIR ","TAB 1GM","21","Select","Select",""],["","81131077943","EQ ","TAB WOMENS","30","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","1","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","16729018317","HYDROCHLOROT ","TAB 25MG","7.5","Select","Select",""],["","71093014706","AMLODIPINE ","TAB 5MG","15","Select","Select",""],["","43547040211","FUROSEMIDE ","TAB 40MG","15","Select","Select",""],["","00799000104","CALMOSEPTINE ","OIN ","113","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":""}]}]}