{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HTIEKDEER ","gend":0,"add":"SIHW 00521YAW GNIREP","city":"MIDLOTHIAN","state":"VA","zip":"23113-2836","dob":"1983-01-17","age":"","mstatus":"","insh":"50010630","cliId":"","pno":"0240876565","cno":"","email":"","ename":"","eno":"","pphy":"VCU CENTER FOR ADVANCED HEALTH","ppno":8042056567,"pcpadd":"MCV Physicians, 2116 W Laburnum Ave Ste 100","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232274359,"pcpcounty":"","pcpid":"","pcpname":"VCU CENTER FOR ADVANCED HEALTH","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"12500 WHISPERING WAY","madd2":"","madd3":"","mcity":"MIDLOTHIAN","mstate":"VA","mzip":"23113-2836","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","D64.89","Z79.01","E11.9","I10","E78.00","D64.9","D50.9","I82.409","L89.302","G82.20","Z86.718","A08.4","E86.0","D72.829","E87.1","I95.9","N17.9","R65.10","M79.81","R57.8","Z20.828","G82.50","I71.00","R78.81","D62","D68.59","I82.401","M79.89","R00.0","R06.02","R07.9","L89.312","S70.10XA","E87.8","I51.7","I77.810","R22.31","I86.2","K85.90","R57.1","E66.9","N43.3","N50.89","I38","I34.0","I82.421","E78.5","F17.200","Z79.84","I82.431","I82.91","Z79.891","Z86.19","I82.4Y1","S80.11XA","I87.2","R60.0","I82.491","L89.322","L89.896","Z51.81","Z68.33","Z86.711","Z89.612","R31.0","N50.82","S91.301A","D65","D68.9","Z20.822","N17.8","N28.9","L89.610","N32.9","R79.89","R79.1","I82.502","I77.6","Z89.511","M31.31","R80.8","R60.9","Z51.11","N01.7","M31.7","D50.8","R31.9","Z09","L89.612","N19","E87.5","E87.2","Z00.00","Z13.220","I12.9","K21.9","N18.4","E11.22","E11.59","R19.5","K22.70","K20.9","K26.9","K29.50","K22.10","F17.210","I25.10","Z79.899","S79.911A","M16.0","W05.0XXA"],"date":["2020-06-19","2020-02-24","2022-03-07","2021-03-17","2022-01-11","2020-06-18","2022-03-07","2022-03-07","2022-01-11","2020-09-11","2021-08-13","2022-03-07","2020-11-29","2020-11-29","2020-11-29","2020-12-15","2020-11-30","2022-01-11","2020-12-01","2020-12-02","2020-12-03","2020-12-01","2020-12-01","2020-12-01","2020-12-10","2021-02-07","2020-12-01","2021-01-22","2021-01-22","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-12-03","2020-12-03","2020-12-08","2020-12-08","2020-12-02","2020-12-02","2020-12-02","2020-12-15","2021-01-06","2020-12-23","2021-01-06","2020-12-10","2020-12-11","2020-12-24","2021-03-13","2021-03-13","2021-01-22","2020-12-23","2020-12-23","2020-12-23","2020-12-23","2021-01-03","2021-01-03","2020-12-23","2020-12-23","2021-01-06","2021-01-06","2021-01-06","2021-01-06","2021-01-06","2021-03-13","2021-08-13","2021-07-12","2021-01-06","2021-01-22","2021-02-02","2021-02-02","2021-01-22","2021-02-06","2021-01-24","2021-01-25","2021-01-25","2021-02-06","2021-02-06","2021-02-01","2022-01-11","2021-02-06","2021-02-06","2021-02-06","2021-02-07","2021-02-26","2022-03-07","2022-03-07","2021-03-17","2021-03-13","2021-02-16","2021-02-24","2021-07-12","2022-01-11","2021-03-13","2021-06-15","2021-06-15","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2019-06-07","2019-06-07","2019-06-07","2019-06-07","2019-06-07","2019-06-07","2019-06-07","2019-06-07","2019-06-07","2019-12-04","2019-12-04","2019-12-04"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","59746017210","PREDNISONE","TAB 5MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","16714003610","ENOXAPARIN","INJ 80\/0.8ML","24","Select","Select",""],["","68645055354","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","68645049554","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","59676058015","JANSSEN","INJ COVID-19","0.5","Select","Select",""],["","57237012501","WARFARIN","TAB 6MG","60","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","60","Select","Select",""],["","00228212710","CLONIDINE","TAB 0.1MG","2","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","43598021055","SSD","CRE 0.01","50","Select","Select",""],["","49281041950","FLUZONE","INJ 2019-20","0.5","Select","Select",""],["","53746017801","METFORMIN","TAB 500MG ER","60","Select","Select",""],["","64980028105","GLIPIZIDE","TAB 10MG","30","Select","Select",""],["","31722062921","ATOVAQUONE","SUS 750\/5ML","280","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","16","Select","Select",""],["","67877012425","SILVER","CRE 0.01","25","Select","Select",""],["","49281072110","FLUBLOK","INJ 2021-22","0.5","Select","Select",""],["","00006483703","PNEUMOVAX","INJ 25\/0.5","0.5","Select","Select",""],["","64980052810","SODIUM","TAB 650MG","60","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","20","Select","Select",""],["","00472032126","HYDROCORT","CRE 0.01","28.4","Select","Select",""],["","00456141090","BYSTOLIC","TAB 10MG","90","Select","Select",""],["","55111015930","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","4,000.00","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4,000.00","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}