{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"C   YDNARBDROFWARC ","gend":1,"add":"DOOW 1191TRUOC NAM","city":"GLEN ALLEN","state":"VA","zip":"23060-2925","dob":"1983-05-23","age":"","mstatus":"","insh":"60017546","cliId":"","pno":"9940859287","cno":8042483115,"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":8042483115,"add2":"APT. C","add3":"","madd1":"1911 WOODMAN COURT","madd2":"APT. C","madd3":"","mcity":"GLEN ALLEN","mstate":"VA","mzip":"23060-2925","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.9","F33.1","K08.89","F17.200","F33.3","F31.2","G89.29","S23.3XXA","Y93.89","M54.6","K02.9","K04.7","Z04.1","V89.2XXA","K05.229","J98.4","F33.2","F31.32","F31.4","R10.9","K52.9","E87.6","F31.9","E86.0","F19.10","D64.9","D47.3","Z79.899","R93.3","A09","D53.9","K52.89","F43.10","F43.12","F14.24","R22.0","F14.10","R10.13","N39.0","R74.8","F32.89","R45.851","Z88.5","R63.0","F11.10","F12.10","Z53.20","Z21","F17.210","Z86.59","Z91.5","R68.89","R07.9","H61.21","Z20.828","D72.829","Z76.5","S16.1XXA","M54.9","M54.2","V43.62XA","Y92.410","M62.830","R10.84","R11.2","F14.90","Z59.0","F31.5","J18.9","R05","F32.9","R10.31","R11.0","M41.84","X58.XXXA","H66.92","H92.02","R10.30","H92.01","R10.32"],"date":["2019-03-14","2020-04-10","2020-02-09","2021-05-18","2021-04-17","2019-05-14","2019-05-21","2019-07-23","2019-07-23","2019-07-28","2019-11-19","2019-11-19","2019-12-03","2019-12-03","2020-02-09","2020-02-13","2020-03-24","2020-06-30","2021-05-17","2021-05-18","2020-10-29","2020-10-29","2020-10-28","2020-10-29","2020-10-28","2020-10-28","2020-10-28","2021-05-18","2020-10-29","2020-10-30","2020-10-30","2020-10-30","2019-09-16","2019-09-30","2019-09-30","2020-02-06","2020-10-27","2021-05-18","2021-05-18","2021-05-18","2019-02-07","2019-09-25","2019-09-25","2019-09-25","2019-09-25","2019-09-25","2019-09-25","2019-09-25","2019-09-25","2019-09-25","2019-09-25","2019-12-03","2020-02-13","2020-02-15","2020-07-08","2020-10-30","2019-11-19","2019-12-03","2019-12-03","2019-12-03","2019-12-03","2019-12-03","2019-12-03","2020-10-16","2021-05-18","2019-02-07","2019-02-07","2020-03-16","2020-02-13","2020-02-13","2020-08-24","2020-10-23","2020-10-23","2019-07-23","2019-07-23","2020-08-24","2020-08-24","2020-10-27","2020-02-15","2021-05-18"],"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":[["","65862019399","FLUOXETINE ","CAP 20MG","28","Select","Select",""],["","33342007015","OLANZAPINE ","TAB 10MG","28","Select","Select",""],["","13107000334","MIRTAZAPINE ","TAB 30MG","15","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","10","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","18","Select","Select",""],["","64980015603","RISAQUAD-2 ","CAP ","30","Select","Select",""],["","00093117410","PENICILLN ","TAB 500MG","30","Select","Select",""],["","67877057505","BENZONATATE ","CAP 200MG","21","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","3","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","24208063110","NEO\/POLY\/HC ","SOL 1% OTIC","10","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","5","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","12","Select","Select",""],["","59779030603","CVS ","POW ","510","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","65862053820","LEVOFLOXACIN ","TAB 750MG","5","Select","Select",""],["","16571020106","DICLOFENAC ","TAB 75MG DR","12","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}