{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THOMAS   L WELLS","gend":0,"add":"MARTHA WILLS, AR","city":"HENRICO","state":"VA","zip":"23222-1220","dob":"1981-03-09","age":"","mstatus":"","insh":10031698,"cliId":"","pno":8049821674,"cno":8049821674,"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":8043216021,"add2":"111 ENGLESIDE DRIVE APT 1D","add3":"","madd1":"MARTHA WILLS, AR","madd2":"111 ENGLESIDE DRIVE APT 1D","madd3":"","mcity":"HENRICO","mstate":"VA","mzip":"23222-1220","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E27.40","G93.41","E23.0","G40.909","E87.6","E87.0","J96.01","J69.0","G40.209","Q04.4","F72","G40.009","E03.8","F79","E55.9","H11.9","R56.9","R63.8","D49.7","G40.919","Q04.0","Z79.899","A41.9","I95.9","N17.9","R53.1","R00.0","I51.7","E87.1","E87.8","E86.0","R63.0","R11.0","Z46.59","R63.4","Z23","R68.89","S01.01XA","X58.XXXA","S42.032A","S02.2XXA","S01.21XA","S05.11XA","W18.39XA","F50.00","G40.109","Z00.00","H10.33","I95.89","E16.2","E46","E63.8","M79.675","R07.9","R10.9","Z48.02","S01.91XA","J90","K64.8","K62.5","R65.10","G40.219","E87.2","H54.8","J98.11","R19.7","E43","Z68.1","R64","Z82.3","H54.7","E87.5","M62.561","M62.562","M79.89","S09.90XA","M27.2","S42.002A","S50.12XA","H10.023","E03.9","W18.30XA","S02.5XXA","R65.20","E11.649","I25.2","R09.89","R91.8","Z46.82","F05","Z79.890"],"date":["2019-08-13","2019-02-19","2020-09-09","2021-04-12","2019-02-13","2019-02-19","2019-02-19","2019-02-19","2019-07-27","2020-09-15","2019-04-03","2019-04-03","2019-08-13","2020-09-15","2019-08-13","2019-08-13","2020-04-13","2019-08-13","2020-03-13","2021-04-12","2020-09-15","2021-04-12","2019-02-11","2019-02-10","2019-02-15","2019-02-10","2019-02-10","2019-07-27","2019-07-27","2019-07-27","2019-07-27","2019-07-27","2019-07-27","2019-08-13","2019-11-26","2019-11-26","2020-03-13","2020-02-16","2020-02-16","2020-04-13","2020-04-13","2020-04-13","2020-04-13","2020-04-13","2020-09-09","2020-09-09","2019-01-18","2019-07-13","2019-08-09","2019-08-09","2019-08-27","2019-09-10","2021-04-12","2019-02-11","2019-02-12","2020-02-25","2020-02-24","2019-02-18","2019-03-18","2019-03-18","2019-02-11","2019-02-11","2019-07-27","2019-02-11","2019-02-12","2019-02-26","2019-07-27","2019-07-27","2019-07-27","2019-07-27","2019-07-27","2019-07-27","2020-04-13","2020-04-13","2020-04-13","2020-04-13","2020-04-13","2020-04-13","2020-04-13","2019-07-13","2021-04-12","2020-04-13","2020-04-13","2019-02-11","2019-02-11","2019-02-11","2019-02-14","2019-02-14","2019-02-14","2020-04-14","2021-04-12"],"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":[["","50474087015","BRIVIACT ","SOL 10MG\/ML","600","Select","Select",""],["","31604002674","D3 ","TAB 2000UNIT","30","Select","Select",""],["","54838054880","LEVETIRACETA ","SOL 100MG\/ML","900","Select","Select",""],["","00005452835","CENTRUM ","CHW ","30","Select","Select",""],["","51672413101","LAMOTRIGINE ","TAB 100MG","60","Select","Select",""],["","65162036110","FOLIC ","TAB 1MG","30","Select","Select",""],["","68180096801","LEVOTHYROXIN ","TAB 88MCG","90","Select","Select",""],["","00904615760","VITAMIN ","TAB 2000UNIT","90","Select","Select",""],["","11822033670","RA ","TAB 100MG","30","Select","Select",""],["","59762007301","HYDROCORT ","TAB 5MG","270","Select","Select",""],["","61314062810","POLYMYXIN ","SOL TRIMETHP","10","Select","Select",""],["","00121077216","HYDROCO\/APAP ","SOL 7.5-325","60","Select","Select",""],["","69315030805","CIPROFLOXACN ","SOL 0.3% OP","5","Select","Select",""],["","00574402435","ERYTHROMYCIN ","OIN 5MG\/GM","3.5","Select","Select",""],["","42806031250","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","00573287110","PREPARATION ","OIN H","28","Select","Select",""],["","66685101201","AMOX\/K ","SUS 400\/5ML","75","Select","Select",""],["","65162071009","COLCHICINE ","TAB 0.6MG","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","",""],["No","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":""}]}]}