{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA HEPLER","gend":1,"add":"8704   PELLINGTON  PLACE                                    ","city":"HENRICO                       ","state":"VA","zip":"23294-4833","dob":"1982-03-19","age":"","mstatus":"","insh":6765312,"cliId":"","pno":5403103583,"cno":5402201522,"email":"","ename":"","eno":"","pphy":"GIUNTA, SUZANNE                                             ","ppno":8042307777,"pcpadd":"4730 N Southside Plaza St                                   ,                                                            ","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232241742,"pcpcounty":"","pcpid":"","pcpname":"VCUHS HAYES E WILLIS HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"8704   PELLINGTON  PLACE                                    ","add3":"","madd1":"8704   PELLINGTON  PLACE                                    ","madd2":"APT 1                                                       ","madd3":"","mcity":"HENRICO                       ","mstate":"VA","mzip":"23294-4833","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.9","V89.2XXA","R07.9","M54.2","R51","S06.0X9A","Y92.410","S13.4XXA","S29.9XXA","F17.200","R40.2362","R40.2142","R40.2252","I10","M79.7","S09.8XXA","F29","E87.6","R44.3","R42","F43.22","R45.851","I12.9","N18.9","J45.909","F11.129","R44.0","R44.1","Z23","Z79.899","Z91.14","M19.90","F11.90","M79.671","S97.81XA","S92.524A","B34.9","J31.2","R05","J02.9","M79.10","G89.29","Z90.710","F11.20","J45.901","R25.2","F41.9","R68.89","R11.0","K90.0","Z20.828","M94.0","F41.8","J42","J30.2","F11.11","F17.210","Z80.3","Z80.0","Z63.5","F32.9","J44.9","B18.2","M62.838","F11.10","B19.20","Z11.59","R61","Z71.89","Z20.5","G62.9","F12.188","Z20.822","F32.A","K59.00","Z59.01","K63.5","Z86.19","K74.00","R51.9","L29.9","L02.214","I89.1","M79.621"],"date":["2020-02-08","2020-02-08","2021-04-12","2020-10-11","2020-02-08","2020-02-08","2020-02-08","2022-03-18","2020-02-08","2020-03-20","2020-02-08","2020-02-08","2020-02-08","2020-03-20","2021-06-23","2020-02-08","2020-02-11","2020-02-10","2020-02-10","2020-02-10","2020-02-12","2020-02-11","2020-02-11","2020-02-11","2021-07-26","2020-02-11","2020-02-11","2020-02-11","2022-01-19","2020-02-11","2020-02-11","2020-02-11","2021-05-26","2020-02-18","2020-02-18","2020-02-18","2020-03-20","2020-03-20","2020-03-20","2020-03-20","2020-03-20","2020-03-20","2020-03-20","2022-12-09","2020-07-02","2020-07-02","2021-10-14","2021-02-28","2022-01-19","2022-01-19","2020-11-23","2021-04-23","2021-06-23","2021-04-29","2021-05-10","2021-12-08","2021-10-14","2021-10-14","2021-07-29","2021-10-14","2021-10-14","2021-10-14","2022-03-17","2021-07-26","2021-10-14","2021-12-08","2021-05-26","2021-07-26","2021-06-23","2021-07-14","2021-10-14","2021-07-29","2021-12-13","2021-10-14","2021-10-14","2021-10-14","2021-12-08","2021-12-08","2022-01-19","2022-01-19","2022-01-19","2022-08-11","2022-10-16","2022-10-16"],"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":[]},{"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":[["","57237001760","DULOXETINE","CAP 20MG","60","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","90","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","120","Select","Select",""],["","00074262528","MAVYRET","TAB 100-40MG","84","Select","Select",""],["","65862014736","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4,000.00","Select","Select",""],["","00904674880","BISACODYL","TAB 5MG EC","2","Select","Select",""],["","00603497528","OXYBUTYNIN","TAB 5MG","90","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","90","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","00527293437","PREDNISONE","TAB 20MG","14","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","90","Select","Select",""],["","45802086802","POLYETH","POW 3350 NF","238","Select","Select",""],["","60505004101","ETODOLAC","TAB 400MG","20","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","64896069701","OXYMORPHONE","TAB 10MG ER","28","Select","Select",""],["","00406853001","OXYCODONE","TAB 30MG","84","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","30","Select","Select",""],["","10702001250","HYDROXYZ","TAB 50MG","90","Select","Select",""],["","69547035302","NARCAN","SPR ","2","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":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"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":""}]}]}