{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ASORECIRT W","gend":1,"add":"IRRAH S 606TEERTS NOS","city":"RICHMOND","state":"VA","zip":"23220-6151","dob":"1957-07-11","age":"","mstatus":"","insh":"50019940","cliId":"","pno":"8640808677","cno":8046476362,"email":"","ename":"","eno":"","pphy":"LUTTERBIE, MARK A","ppno":8048285883,"pcpadd":"401 N 11th St # Ref, ","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232191901,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":8044829744,"add2":"APT A","add3":"","madd1":"606 S Harrison St Apt A","madd2":"                                                            ","madd3":"","mcity":"Richmond","mstate":"VA","mzip":"23220-6151","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M13.811","J45.901","B34.8","B97.81","I10","E11.9","I51.7","R94.31","R07.9","E78.5","R10.9","Z79.899","F33.1","F41.1","M25.511","R22.33","R22.43","E78.00","H93.8X1","H25.13","J06.9","R06.00","J44.1","E03.9","E87.6","Z87.891","J98.01","K21.9","K27.9","I95.9","E13.9","R74.8","M79.644","M25.562","R05","Z79.84","M25.462","M17.0","M19.011","M19.012","M62.838","T78.40XA","F25.1","M62.81","N63.22","Z23","U07.1","J12.89","J96.01","Z79.82","M79.18","Z80.0","Z82.49","J45.20","J45.22","M54.5","F32.9","R51","E66.9","M25.569","Z68.41","J02.9","R06.2","J45.909","E07.9","Z79.890","S99.922A","W20.8XXA","F17.200","H92.01","M54.9","M54.2","R61","N63.42","R51.9","M13.819","Z01.812","E66.01","B97.89","B97.0","Z79.51","M19.041","R25.2","Z12.31","H52.4","H52.203","H35.362","N63.20","Z96.611","M17.11","M17.12","G72.9","R06.02","S29.012A","R07.89","M54.6","X58.XXXA","S46.811A","S46.812A","M25.50","S99.921A","R68.89","R50.9","Z03.89","M79.641","Z86.2","S30.1XXA","G89.29","M17.9","R91.8","R09.89","M79.10","W22.8XXA","H92.03","E89.0","W22.03XA","Y93.89","G47.62","J12.82"],"date":["2019-03-13","2019-04-17","2019-04-17","2019-04-17","2021-01-19","2021-01-19","2019-04-16","2020-12-29","2019-04-16","2020-10-07","2019-05-20","2020-01-29","2020-08-05","2019-02-17","2019-01-21","2019-01-21","2019-01-21","2019-01-21","2019-08-19","2020-08-20","2019-11-07","2020-12-29","2019-04-12","2021-01-19","2019-04-12","2020-10-07","2019-04-12","2020-12-29","2019-04-17","2019-04-17","2019-07-24","2020-01-29","2019-08-19","2019-11-23","2020-12-17","2020-10-07","2019-10-24","2020-03-11","2020-09-09","2020-09-09","2020-03-11","2020-06-01","2021-05-12","2020-10-12","2020-10-12","2020-10-12","2021-01-19","2020-12-30","2020-12-30","2020-12-29","2020-12-30","2020-12-29","2020-12-29","2019-11-12","2019-11-12","2021-05-20","2021-05-20","2020-07-25","2021-05-20","2020-03-25","2020-03-25","2020-07-25","2020-07-25","2020-10-07","2020-07-25","2020-07-25","2019-01-05","2019-01-05","2019-11-23","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-10-22","2021-05-20","2019-04-01","2019-04-01","2019-04-12","2019-04-12","2019-04-12","2019-04-12","2019-08-19","2019-12-03","2019-10-14","2020-08-20","2020-08-20","2020-08-20","2020-10-22","2019-03-13","2020-09-09","2020-09-09","2020-01-29","2020-07-08","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-12-30","2019-01-05","2019-05-20","2019-04-06","2019-04-06","2019-07-24","2019-07-24","2019-08-29","2019-11-23","2019-12-03","2020-12-29","2020-12-29","2020-09-09","2019-01-05","2019-04-05","2019-04-11","2019-08-29","2019-08-29","2019-09-12","2021-01-19"],"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":[["","57237001830","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","00591024005","LORAZEPAM ","TAB 0.5MG","10","Select","Select",""],["","70010049101","METFORMIN ","ER ORAL TAB","60","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","59762045001","COLESTIPOL ","TAB 1GM","120","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","54629007501","MULTI-VIT\/ ","TAB MINERALS","30","Select","Select",""],["","63739047848","DOCUSATE ","CAP 100MG","60","Select","Select",""],["","64380071206","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","69238183301","LEVOTHYROXIN ","TAB 88MCG","30","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","60505265601","TRIAMT\/HCTZ ","TAB 37.5-25","30","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","65862056099","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","14","Select","Select",""],["","60432060416","PROMETHAZINE ","SYP DM","120","Select","Select",""],["","60505017009","PRAVASTATIN ","TAB 40MG","30","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","12","Select","Select",""],["","65862019105","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","18","Select","Select",""],["","69097012203","TOPIRAMATE ","TAB 25MG","360","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","51660093901","CETIRIZINE ","TAB 10MG","90","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","15","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","17478071710","KETOTIF ","DRO 0.025%OP","5","Select","Select",""],["","10702025301","BUT\/APAP\/CAF ","TAB ","12","Select","Select",""],["","11822316500","RA ","CAP 100MG","60","Select","Select",""],["","61314064511","NEO\/POLY\/HC ","SUS 1% OTIC","10","Select","Select",""],["","68382032001","POT  CHLORIDE","TAB 10MEQ ER","20","Select","Select",""],["","68462019001","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","200","Select","Select",""],["","59762444002","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00193731150","CONTOUR ","NEXT","50","Select","Select",""],["","00193658621","MICROLET ","LANCETS","100","Select","Select",""],["","00527058601","DICYCLOMINE ","10MG","60","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","20","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":""}]}]}