{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  OINOTNANITRAM C ","gend":0,"add":"ELTSAC 2153DAOR DOOW ","city":"RICHMOND","state":"VA","zip":"23234-2126","dob":"1960-06-16","age":"","mstatus":"","insh":"60019027","cliId":"","pno":"0540863402","cno":8049976544,"email":"","ename":"","eno":"","pphy":"REYNOLDS-CANE, DIANNE LENA","ppno":8047800840,"pcpadd":"2809 North Ave Ste 206, ","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232223647,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":8042009404,"add2":"                                                            ","add3":"","madd1":"3512 CASTLE WOOD ROAD","madd2":"                                                            ","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23234-2126","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.2","F10.20","M48.10","F10.10","F33.1","F31.5","M25.562","W19.XXXA","M79.662","M87.88","S09.90XA","M79.605","W01.0XXA","S82.63XA","F25.0","R74.0","I10","D70.9","M87.852","M25.452","Z02.9","M85.852","M21.952","R68.89","F10.129","M89.9","F10.120","I77.1","M87.052","M25.552","Z72.0","D63.8","M62.838","L30.8","K29.70","S01.01XD","X58.XXXD","F10.229","R55","G31.9","R26.89","R03.1","F10.929","M87.352","R07.9","T14.90XA","M87.9","R21","F17.200","F17.210","R29.6","M79.609","R10.84","Y90.8","Z91.83","T68.XXXA","E16.2","I16.0","S19.9XXA","M47.812","S89.92XA","S01.01XA","R51","M54.2","W01.198A","Z23","T51.0X1A","Y09","S01.81XA","Z48.02","S82.832A","M77.32","R91.8","R45.851","Z90.5","M87.851","I45.9","I25.2"],"date":["2020-11-15","2020-03-03","2019-08-02","2020-06-24","2019-12-01","2019-10-06","2021-05-06","2021-05-06","2020-05-04","2020-06-01","2020-06-01","2021-05-06","2020-06-01","2021-05-06","2019-07-21","2020-03-03","2021-04-03","2020-03-03","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-07-11","2021-04-03","2019-05-25","2019-05-25","2019-05-25","2019-07-02","2020-06-02","2019-08-02","2019-08-02","2019-08-16","2019-08-16","2020-06-24","2020-08-04","2020-08-04","2021-04-03","2020-06-01","2019-05-25","2020-02-29","2020-02-29","2021-04-03","2020-06-01","2020-06-01","2020-06-01","2021-05-06","2020-06-02","2020-07-10","2019-07-02","2020-06-01","2020-06-23","2020-06-24","2021-04-03","2021-04-03","2021-05-06","2021-05-06","2021-05-06","2019-05-25","2019-05-25","2020-05-04","2020-07-10","2020-07-10","2020-07-10","2020-07-10","2020-07-10","2020-07-11","2020-07-11","2020-07-11","2020-08-04","2021-05-06","2021-05-06","2021-05-06","2020-02-29","2020-02-29","2019-07-02","2020-06-01","2020-06-01"],"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":[["","58160082311","SHINGRIX ","INJ 50MCG","1","Select","Select",""],["","66993087861","CALCIPOTRIEN ","OIN 0.00005","60","Select","Select",""],["","11822033670","RA ","TAB 100MG","30","Select","Select",""],["","67877019905","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","52817032010","BACLOFEN ","TAB 10MG","30","Select","Select",""],["","51660093901","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00093506001","HYDROXYZ ","TAB 10MG","30","Select","Select",""],["","65162036110","FOLIC ","TAB 1MG","30","Select","Select",""],["","43547035410","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","45802013132","HALOBETASOL ","OIN 0.0005","50","Select","Select",""],["","65162018910","NAPROXEN ","TAB 375MG","10","Select","Select",""],["","65162046510","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","65162062710","TRAMADOL ","TAB 50MG","10","Select","Select",""],["","58160089652","FLUARIX ","INJ 2019-20","0.5","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":""}]}]}