{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EDWIN ALLEY","gend":0,"add":"100 DALE DRIVE","city":"GREENBAY","state":"VA","zip":"23942-2479","dob":"1957-04-15","age":"","mstatus":"","insh":10048087,"cliId":"","pno":4345695315,"cno":4345695315,"email":"","ename":"","eno":"","pphy":"BONAGIRI, VARA P","ppno":4343929000,"pcpadd":"1400 Milnwood Rd, ","pcpcity":"Farmville","pcpstate":"VA","pcpzip":239012579,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"100 DALE DRIVE","madd2":"                                                            ","madd3":"","mcity":"GREENBAY","mstate":"VA","mzip":"23942-2479","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.9","K66.0","Z09","Z71.89","Z71.3","I11.0","J96.01","J18.1","J44.1","J44.0","N28.9","T50.2X5A","R40.2412","E78.5","K21.9","F10.10","R07.9","I73.9","N40.0","F12.90","I21.4","J18.9","J98.4","R91.8","J90","J96.21","R10.9","I10","I50.43","I13.0","I25.10","N18.3","I25.2","I65.22","J44.9","E83.42","F32.9","G47.00","I50.22","I70.8","Z95.5","Z87.891","R68.89","I67.2","R53.1","G31.9","R09.89","S22.42XA","N17.9","R42","R63.0","R53.83","Z85.118","R04.2","I16.1","F17.210","Z90.2","Z79.899","I25.5","I25.119","I65.29","I42.9","I42.8","I51.7","J96.00","I50.23","Z95.810","E78.00","C34.90","G47.33","Z45.02","N18.31","E87.6","N18.9","R93.1","Z79.82","D72.829","K80.20","K56.609","R55","Z79.01","S22.32XD","I50.30","M19.90","M54.5","Z79.51","Z08","I65.23","I70.213","F17.200","Z95.820","R06.00","Z11.59","I49.9","I49.3","I50.20","Z88.0","Z91.041","Z79.02","Z79.52","Z98.1","Z45.09","J84.9","R07.89","T81.89XA","T81.41XA","T81.30XA","I31.3","E87.1","L02.91","T81.31XA","J81.0","J91.8","I34.0","I36.1","J81.1","J98.11","R91.1","W10.9XXA","S06.0X1A","E86.9","F10.20","F43.10","G89.29","S29.9XXA","S39.92XA","S39.93XA","S19.9XXA","M47.812","I20.8","J43.9","W18.30XA","Y92.009","I95.9","E83.39","M25.512","R74.8","R06.02","D64.9","I50.1","I08.1","I27.20","R60.0","M79.89","Z98.890","Z72.0","R06.9","S22.32XA","Z01.818","K68.11","R10.84","R11.0","M54.9","I45.81","Z12.2","I70.599","I77.9","F12.10","R80.9","Z13.0","J43.2","F17.290","J21.9","Z86.73","R40.4","S09.90XA","Z12.5","R73.03","I21.09","R94.31","R60.9","N18.30","K76.89","R09.02","R06.2","I34.8","M51.36","Z23","I21.9","I77.1","I28.8","I27.22","N26.1"],"date":["2021-04-05","2019-04-18","2020-01-13","2020-12-23","2020-04-13","2021-01-22","2021-02-07","2019-04-11","2020-02-26","2019-04-11","2021-01-28","2019-04-11","2019-04-11","2021-03-12","2021-03-12","2021-02-08","2021-02-07","2021-02-03","2019-10-15","2021-01-21","2019-10-22","2019-04-11","2019-04-11","2020-02-28","2020-12-22","2019-04-18","2019-04-18","2021-03-12","2019-10-22","2021-03-25","2021-03-25","2019-10-21","2021-02-07","2019-10-15","2021-03-25","2021-03-16","2021-02-07","2020-02-13","2021-03-25","2020-06-15","2021-03-25","2021-03-25","2020-01-21","2020-01-09","2020-01-09","2020-01-09","2020-01-09","2020-01-09","2021-02-11","2020-01-09","2020-01-09","2020-01-09","2021-03-12","2020-02-13","2020-02-27","2021-03-16","2020-11-20","2021-03-16","2021-02-23","2020-11-23","2020-12-22","2021-03-12","2021-01-28","2021-01-29","2021-02-11","2021-02-11","2021-03-25","2021-02-09","2021-02-09","2021-02-08","2021-02-23","2021-03-16","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2019-01-04","2020-12-22","2019-02-15","2020-02-26","2021-01-22","2020-03-16","2020-11-23","2020-03-16","2020-03-16","2021-01-28","2020-05-08","2021-01-12","2020-11-10","2021-02-03","2020-11-10","2021-01-19","2021-03-25","2021-01-19","2021-01-28","2021-02-03","2021-03-12","2021-03-12","2021-01-28","2021-01-28","2021-03-12","2021-01-29","2021-01-29","2019-10-14","2019-01-02","2019-01-02","2019-01-02","2019-01-02","2019-05-21","2019-01-02","2019-01-02","2019-04-11","2019-04-11","2019-04-12","2019-04-12","2020-12-22","2019-04-17","2019-10-22","2019-05-21","2019-05-21","2019-05-21","2019-05-21","2019-05-21","2019-10-14","2019-05-21","2019-05-21","2019-05-21","2019-05-21","2019-05-21","2019-10-22","2020-12-22","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2020-02-27","2021-02-07","2020-04-13","2020-10-26","2020-10-26","2021-03-12","2021-02-07","2021-02-07","2019-02-07","2021-02-07","2020-02-25","2020-02-26","2020-12-15","2019-01-02","2019-01-02","2019-01-02","2019-05-21","2019-10-21","2019-11-14","2020-12-22","2020-12-22","2021-02-03","2021-03-25","2021-03-25","2019-02-15","2019-02-15","2019-02-15","2020-01-09","2019-05-21","2019-05-21","2020-04-13","2020-12-23","2020-10-26","2020-10-26","2021-02-07","2021-02-07","2019-04-11","2019-04-11","2019-04-11","2019-10-15","2020-12-23","2021-05-13","2019-10-15","2021-01-12","2019-10-15","2021-03-12","2021-03-25"],"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":[["","16714033202","GABAPENTIN ","TAB 800MG","120","Select","Select",""],["","68382013201","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","68645049254","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","16729017317","AMITRIPTYLIN ","TAB 50MG","30","Select","Select",""],["","68645055154","LISINOPRIL ","TAB 5MG","30","Select","Select",""],["","68382066010","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","60505025303","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00093092810","LOVASTATIN ","TAB 40MG","30","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","58657015010","FOLIC ","TAB 1MG","30","Select","Select",""],["","00093505898","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","43547040211","FUROSEMIDE ","TAB 40MG","60","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","14","Select","Select",""],["","50111091701","TORSEMIDE ","TAB 20MG","60","Select","Select",""],["","31722070090","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","65862014505","CARVEDILOL ","TAB 25MG","60","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","00085461001","DULERA ","AER 200-5MCG","13","Select","Select",""],["","51672131201","MUPIROCIN ","OIN 0.02","15","Select","Select",""],["","68645057154","CITALOPRAM ","TAB 40MG","30","Select","Select",""],["","65162017810","METFORMIN ","50 0MG ER","30","Select","Select",""],["","13668010401","ISOSORB ","TAB 30MG ER","90","Select","Select",""],["","31722072250","LEVOFLOXACIN ","TAB 500MG","3","Select","Select",""],["","00078065920","ENTRESTO ","TAB 24-26MG","60","Select","Select",""],["","00597015561","STIOLTO ","AER 2.5-2.5","4","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","10","Select","Select",""],["","42858000101","OXYCODONE ","TAB 5MG","7","Select","Select",""],["","49035019402","EQ ","DIS 21MG\/24H","28","Select","Select",""],["","50111078810","AZITHROMYCIN ","TAB 500MG","7","Select","Select",""],["","57237010099","METOPROL ","TAB 25MG","60","Select","Select",""],["","59746012106","MECLIZINE ","TAB 25MG","20","Select","Select",""],["","60258017101","MAG ","TAB 400MG","120","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","9","Select","Select",""],["","63304061650","DOXYCYC ","CAP 100MG","14","Select","Select",""],["","00487980125","IPRATROPIUM ","SOL 0.02%INH","125","Select","Select",""],["","31722099601","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","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","",""],["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":""}]}]}