{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SCHKERA   M BROWN","gend":1,"add":"1026   ST PAUL  STREET                                      ","city":"RICHMOND                      ","state":"VA","zip":"23220-2435","dob":"1985-05-25","age":"","mstatus":"","insh":10048222,"cliId":"","pno":8047092340,"cno":8047092340,"email":"","ename":"","eno":"","pphy":"VCU CENTER FOR ADVANCED HEALTH                              ","ppno":"","pcpadd":"MCV Physicians","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232274359,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"APARTMENT 2                                                 ","add3":"","madd1":"1026   ST PAUL  STREET                                      ","madd2":"APARTMENT 2                                                 ","madd3":"","mcity":"RICHMOND                      ","mstate":"VA","mzip":"23220-2435","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R11.2","F17.210","Z79.899","Z30.46","Z68.30","Z30.09","R10.84","K43.9","K43.6","R00.1","I49.9","K42.9","F31.9","J30.9","J06.9","M72.2","M79.671","S51.811A","S61.521A","W26.8XXA","S61.511A","X99.0XXA","Y92.009","S51.811D","Z48.02","K52.9","F17.200","S00.502A","S01.512A","X58.XXXA","H10.89","H57.89","Z79.891","S80.261A","W57.XXXA","M79.672","S90.32XA","W22.8XXA","Z79.1"],"date":["2021-03-15","2021-09-09","2021-09-09","2019-03-15","2019-03-15","2019-03-15","2019-04-02","2019-04-18","2019-04-22","2019-04-18","2019-04-18","2019-04-22","2019-06-14","2019-10-30","2019-10-30","2020-07-07","2020-07-07","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2020-09-08","2020-09-08","2021-03-15","2021-06-21","2021-03-20","2021-03-20","2021-09-09","2021-04-17","2021-04-17","2021-04-17","2021-06-21","2021-06-21","2021-09-09","2021-09-09","2021-09-09","2021-09-09"],"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":[["","65162019050","NAPROXEN","500MG","20","Select","Select",""],["","00093005805","TRAMADOL","50MG","8","Select","Select",""],["","25866052812","ALEVE","220MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","49483060350","IBUPROFEN","600MG","15","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","24208083060","NEO\/POLY\/DEX","0.1% OP","5","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","8","Select","Select",""],["","25866052812","ALEVE ","CAP 220MG","30","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","49483060350","IBUPROFEN ","TAB 600MG","15","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","24208083060","NEO\/POLY\/DEX ","SUS 0.1% OP","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":[[["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":""}]}]}