{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRIAN AYLOR","gend":0,"add":"1811   CLIFFBROOK LANE                                      ","city":"RICHMOND                      ","state":"VA","zip":"23227-2456","dob":"1974-09-01","age":"","mstatus":"","insh":10048174,"cliId":"","pno":8045172399,"cno":8045172399,"email":"","ename":"","eno":"","pphy":"MORRIS, RANDALL ","ppno":"","pcpadd":"10150 Staples Mill Rd Ste C,Ste 2100","pcpcity":"Glen Allen                    ","pcpstate":"VA","pcpzip":230603452,"pcpcounty":"","pcpid":"P0123404","pcpname":"CROSSRIDGE PEDIATRICS & INTERNAL MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"APT F                                                       ","add3":"","madd1":"1811   CLIFFBROOK LANE                                      ","madd2":"APT F                                                       ","madd3":"","mcity":"RICHMOND                      ","mstate":"VA","mzip":"23227-2456","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.9","F41.1","F60.3","E00.9","M79.7","K58.9","K21.9","E66.9","J30.1","K58.1","K21.0","E03.9","E78.00","I10","R73.9","E55.9","Z68.35","R68.89","R10.9","R10.11","R10.12","R00.0","E66.01","J30.2","M67.432","R20.2","G47.9","S19.9XXA","S09.90XA","S62.617A","S01.81XA","S62.502A","M71.332","Z68.36","M25.642","S62.617D","M79.645","R29.898","M62.81","R07.89","S99.922S","G62.9","J06.9"],"date":["2021-11-29","2021-11-29","2021-11-29","2021-10-29","2021-10-29","2021-10-29","2021-10-29","2021-10-29","2019-04-17","2019-04-17","2019-04-17","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2019-12-03","2019-12-03","2019-12-03","2019-12-03","2019-12-03","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-07-10","2020-07-10","2020-08-27","2020-07-10","2020-07-20","2020-07-20","2020-07-20","2020-10-15","2020-10-15","2020-10-15","2020-10-15","2020-09-17","2021-02-23","2021-02-23","2021-02-23","2021-08-04"],"priorHcc":[null,null,null,null,null,null,null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","30","Select","Select",""],["","16729017401","AMITRIPTYLIN","75MG","90","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","54629409760","NAC","600MG","180","Select","Select",""],["","37000040514","METAMUCIL","0.52GM","30","Select","Select",""],["","68180044801","QUETIAPINE","200MG","30","Select","Select",""],["","00527058601","DICYCLOMINE","10MG","30","Select","Select",""],["","69315013601","BENZTROPINE","0.5MG","30","Select","Select",""],["","68645055254","LISINOPRIL","10MG","90","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0.5","Select","Select",""],["","16714008310","HYDROXYZ","50MG","90","Select","Select",""],["","05388062808","MELATONIN","3MG","60","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","9","Select","Select",""],["","81131008747","SV","3MG","61","Select","Select",""],["","65862069730","VENLAFAXINE","150MG ER","30","Select","Select",""],["","00093720110","PRAVASTATIN","20MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","68645056354","IBUPROFEN","800MG","15","Select","Select",""],["","49035061246","ALLERGY","10MG","30","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","21","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","16729017401","AMITRIPTYLIN ","TAB 75MG","90","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","54629409760","NAC ","CAP 600MG","180","Select","Select",""],["","37000040514","METAMUCIL ","CAP 0.52GM","30","Select","Select",""],["","68180044801","QUETIAPINE ","TAB 200MG","30","Select","Select",""],["","00527058601","DICYCLOMINE ","CAP 10MG","30","Select","Select",""],["","69315013601","BENZTROPINE ","TAB 0.5MG","30","Select","Select",""],["","68645055254","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","70461032003","FLUCLVX ","INJ 2020-21","0.5","Select","Select",""],["","16714008310","HYDROXYZ ","TAB 50MG","90","Select","Select",""],["","05388062808","MELATONIN ","TAB 3MG","60","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","9","Select","Select",""],["","81131008747","SV ","TAB 3MG","61","Select","Select",""],["","65862069730","VENLAFAXINE ","CAP 150MG ER","30","Select","Select",""],["","68645056354","IBUPROFEN ","TAB 800MG","15","Select","Select",""],["","00093720110","PRAVASTATIN ","TAB 20MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","49035061246","ALLERGY ","TAB 10MG","30","Select","Select",""],["","57237002801","AMOXICILLIN ","TAB 500MG","21","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":""}]}]}