{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" GLORIA A CARLYLE","gend":1,"add":"1805 PARLOW DRIVE","city":"RICHMOND","state":"VA","zip":"23222-1751","dob":"1954-04-25","age":"","mstatus":"","insh":10028709,"cliId":"","pno":"8043211512, 8043215812","cno":8043211512,"email":"","ename":"","eno":"","pphy":"UNKNOWN PROVIDER QNXT PCP","ppno":"               ","pcpadd":"UNKNOWN STREET, ","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":232190000,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1805 PARLOW DRIVE","madd2":"                                                            ","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23222-1751","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T81.31XD","M79.673","R07.89","M06.4","M34.82","M10.9","R06.02","Z79.899","Z79.891","M34.9","R07.9","M79.7","M05.79","M34.89","M17.10","M19.071","M19.072","E79.0","I73.00","K21.9","K29.00","K92.1","D50.9","K58.1","E11.9","M17.0","F06.33","Z68.31","I63.9","I27.20","I10","Z92.29","H93.299","I11.9","R94.31","M35.1","K22.8","Z87.891","I51.7","K22.4","R10.9","J44.9","E66.9","Z68.32","Z79.82","R53.1","L97.529","R93.6","Z47.89","M77.40","R79.9","R79.89","E53.8","R63.4","E55.9","R06.00","J98.4","M35.9","M34.0","M15.2","M25.461","M19.90","M35.00","M05.9","K27.9","I25.2","E11.65","J84.9","R06.09","Z79.4","N17.9","I25.10","F31.9","N18.3","E11.69","E11.22","R60.9","F31.81","Z68.34","Z13.31","N18.30","D49.7","M54.12","I21.09","I49.1","R63.0","K58.9","E78.5","G89.29","R94.39","M34.81","J44.1","J96.01","R00.0","M06.9","M15.9","K58.2","R68.89","E83.42","R56.9","M19.019","M47.812","Z79.02","Z79.51","M34.1","M47.817","E86.9","E87.1","J98.11","R51.9","M79.605","M79.604","W01.198A","Y93.01","Y92.010","M10.09","S00.03XA","E07.9","G44.319","W01.0XXA","W22.8XXA","M47.22","M54.2","G89.11","I42.9","E86.0","Z00.00","Z13.820","M51.16","M48.061","Z78.0","M81.0","J42","R19.7","D63.8","R50.9","M79.10","F32.9","Z68.30","I12.9","S09.90XA","J06.9","L08.9","M79.601","M62.81","R51","J45.909","M25.011","M19.011","M25.511","R13.14","E66.01","J90","N28.1","I70.0","Z90.710","E87.6","M43.16","K29.70","R06.2","Z86.39","R79.0","Z71.3","M25.569","Z79.52","R09.02","M54.5","M80.00XD","M25.50","G60.9"],"date":["2019-05-15","2019-02-13","2020-04-23","2019-02-19","2019-02-19","2020-11-30","2021-03-17","2020-11-30","2019-08-20","2020-08-31","2020-08-31","2020-01-21","2019-07-09","2019-07-09","2019-07-09","2019-07-09","2019-07-09","2019-07-09","2020-04-28","2020-08-31","2019-09-10","2019-10-15","2020-12-08","2020-05-14","2020-11-30","2019-10-28","2021-03-17","2020-10-26","2020-12-16","2020-08-12","2021-03-17","2021-03-17","2020-04-08","2021-03-17","2021-03-17","2020-06-08","2020-06-05","2020-08-31","2020-08-24","2020-08-31","2020-08-31","2020-11-30","2020-08-31","2020-08-31","2020-11-30","2020-08-12","2019-02-13","2019-02-13","2019-05-15","2019-05-15","2020-09-29","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2020-04-23","2019-07-18","2019-07-18","2020-12-16","2019-10-08","2019-10-08","2020-05-14","2020-04-15","2020-04-28","2020-12-16","2020-06-05","2020-06-08","2020-06-08","2020-06-08","2020-06-25","2020-06-08","2020-06-08","2020-06-08","2020-09-29","2020-06-25","2021-03-17","2020-11-19","2020-11-19","2020-11-19","2021-03-17","2021-03-17","2021-05-05","2021-05-05","2019-02-05","2019-03-10","2019-03-10","2019-10-15","2019-03-10","2021-04-06","2019-03-12","2019-05-28","2020-06-05","2019-06-25","2019-06-26","2020-11-30","2020-08-12","2019-08-06","2020-06-08","2020-06-05","2020-08-12","2020-08-12","2021-04-06","2021-04-02","2019-06-25","2019-03-12","2019-10-28","2020-06-05","2020-06-05","2020-08-24","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2021-04-06","2021-04-06","2021-04-06","2019-03-11","2019-06-22","2020-09-29","2019-09-05","2019-10-08","2019-09-05","2019-09-05","2020-10-26","2019-12-06","2019-12-06","2020-04-15","2020-04-28","2020-04-28","2020-04-28","2020-09-29","2020-09-29","2020-11-30","2021-02-25","2021-02-25","2019-02-20","2019-02-20","2019-02-20","2019-05-31","2019-05-31","2019-05-31","2019-05-31","2019-09-10","2019-09-10","2020-04-23","2019-02-05","2019-02-05","2019-06-25","2019-06-25","2019-10-08","2019-09-10","2019-12-06","2019-12-06","2020-01-10","2020-02-10","2020-03-16","2020-06-07","2019-06-24","2019-07-09","2019-07-09","2019-07-25","2019-08-28"],"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":[["","69097012615","AMLODIPINE ","TAB 2.5MG","30","Select","Select",""],["","00378456105","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","50111091601","TORSEMIDE ","TAB 10MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","00254200811","COLCHICINE ","TAB 0.6MG","60","Select","Select",""],["","68382011505","RISPERIDONE ","TAB 2MG","30","Select","Select",""],["","16714075301","HYDROXYCHLOR ","TAB 200MG","60","Select","Select",""],["","00781520710","LOSARTAN\/HCT ","TAB 100-25","30","Select","Select",""],["","10702000301","PROMETHAZINE ","TAB 25MG","60","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","68180048602","PRAVASTATIN ","TAB 20MG","30","Select","Select",""],["","16714089803","LORATADINE ","TAB 10MG","30","Select","Select",""],["","49483048110","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","60258017101","MAG ","TAB 400MG","30","Select","Select",""],["","57896070310","IRON ","TAB 325MG","90","Select","Select",""],["","00245010811","FERROUS ","TAB 325MG EC","90","Select","Select",""],["","00603533821","PREDNISONE ","TAB 10MG","30","Select","Select",""],["","00406012401","HYDROCO\/APAP ","TAB 7.5-325","120","Select","Select",""],["","00487950160","ALBUTEROL ","NEB 0.00083","540","Select","Select",""],["","11534016503","FOLIC ","TAB 1MG","30","Select","Select",""],["","62332006230","LEFLUNOMIDE ","TAB 20MG","30","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","90","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":""}]}]}