{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALAHNA   N WHITNER","gend":1,"add":"2105 LAUDERDALE DRIVE","city":"HENRICO","state":"VA","zip":"23238-3938","dob":"2001-02-02","age":"","mstatus":"","insh":10042007,"cliId":"","pno":8047402367,"cno":8047402367,"email":"","ename":"","eno":"","pphy":"KUM-NJI, PHILIP","ppno":8048289300,"pcpadd":"1000 E Broad St, ","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232191930,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"2105 LAUDERDALE DRIVE","madd2":"                                                            ","madd3":"","mcity":"HENRICO","mstate":"VA","mzip":"23238-3938","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.23","Q93.81","D82.1","D69.6","Z79.899","D84.9","Q20.0","Z98.890","Z86.79","D69.1","N62","Z01.818","K59.00","F32.9","M79.651","M79.652","D68.0","L70.9","I45.10","J45.20","E55.9","R06.83","H90.12","H93.13","H92.02","H69.92","H52.13","H50.332","Q10.0","M54.2","F43.21","Z23","J45.909","D84.8","R41.840","F81.9","G24.5","R11.0","R51","R07.0","F41.1","R10.31","R01.1","E03.9","Z95.2","Z79.84","H02.401","H02.402","H92.09","H61.23","Q35.9","R73.03","R53.83","Z87.74","E70.330","H66.92","H91.90","G89.18","N64.89","N64.4","E83.51","N92.6","J30.9","D84.89","H90.0","I51.7","I36.1","Z87.798","D56.3","N91.2"],"date":["2019-08-08","2021-01-22","2021-03-17","2020-03-10","2021-02-11","2020-07-15","2020-09-17","2020-09-17","2020-09-17","2019-03-05","2020-11-18","2019-09-25","2019-09-25","2019-10-07","2019-09-25","2019-09-25","2020-07-15","2019-09-25","2020-09-17","2021-03-17","2021-03-17","2020-02-26","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2019-03-26","2019-03-26","2019-03-26","2019-09-16","2019-11-20","2019-11-20","2020-11-16","2020-05-26","2020-11-16","2020-11-16","2019-05-22","2019-09-16","2019-09-16","2019-09-16","2019-09-16","2019-09-16","2019-09-16","2021-02-11","2019-09-16","2019-09-16","2019-10-07","2019-10-07","2020-07-15","2020-07-15","2020-07-15","2021-02-02","2019-03-14","2019-03-14","2020-01-24","2020-04-28","2020-03-10","2020-11-23","2020-11-23","2020-11-23","2021-02-11","2021-02-11","2021-03-17","2021-03-17","2020-07-15","2020-09-17","2020-09-17","2020-09-17","2021-03-09","2021-03-09"],"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":[["","00904615760","VITAMIN ","TAB 2000UNIT","60","Select","Select",""],["","00065427325","PAZEO ","DRO 0.007","2.5","Select","Select",""],["","69918030130","TRANEX ","TAB 650MG","30","Select","Select",""],["","00053687100","STIMATE ","SOL 1.5MG\/ML","2.5","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","5","Select","Select",""],["","53746017901","METFORMIN ","TAB 750MG ER","90","Select","Select",""],["","00536410602","OYSCO ","TAB 500MG","60","Select","Select",""],["","00378180510","LEVOTHYROXIN ","TAB 75MCG","30","Select","Select",""],["","65162089129","MOMETASONE ","SPR 50MCG","17","Select","Select",""],["","50428444238","CVS ","TAB 10MG","30","Select","Select",""],["","69238159608","AMINOCAPROIC ","SOL 0.25\/ML","473","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","4","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","80681000400","OYSTER ","TAB 500MG","180","Select","Select",""],["","24208091055","ERYTHROMYCIN ","OIN OP","3.5","Select","Select",""],["","00904671980","ACETAMINOPHEN ","TA B 325","50","Select","Select",""],["","00904645760","DOK ","CAP 100MG","60","Select","Select",""],["","00093742698","MONTELUKAST ","TAB 10MG","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}