{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAKIRA   D BRIGHT","gend":1,"add":"1600   OAK PLACE BOULEVARD                                  ","city":"RICHMOND                      ","state":"VA","zip":"23231-4866","dob":"2001-09-21","age":"","mstatus":"","insh":10048228,"cliId":"","pno":8046121966,"cno":8046877868,"email":"","ename":"","eno":"","pphy":"BUSH, JAMES A","ppno":"","pcpadd":"815 W POYTHRESS ST","pcpcity":"HOPEWELL                      ","pcpstate":"VA","pcpzip":238602532,"pcpcounty":"","pcpid":"P0118404","pcpname":"HOPEWELL MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"APT 202                                                     ","add3":"","madd1":"1600   OAK PLACE BOULEVARD                                  ","madd2":"APT 202                                                     ","madd3":"","mcity":"RICHMOND                      ","mstate":"VA","mzip":"23231-4866","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B37.9","Z71.89","Z71.3","E10.9","S70.362A","W57.XXXA","E10.65","R82.4","E10.10","J45.909","L29.9","E86.0","E55.9","K59.00","Z79.4","Z79.899","Z83.3","Z91.19","Z91.040","E11.65","R73.9","R11.0","K21.9","N92.6","R39.9","R68.89","F41.0","E16.2","Z77.22","N89.8","Z20.828","K76.89","R10.9","I10"],"date":["2019-02-08","2020-02-10","2020-02-10","2021-03-09","2019-05-10","2019-05-10","2021-05-18","2019-07-16","2019-09-08","2019-09-08","2019-09-08","2019-12-06","2019-09-08","2019-09-08","2020-01-27","2019-09-08","2019-09-08","2019-09-08","2019-09-08","2020-01-27","2019-12-06","2019-12-06","2020-01-27","2020-02-10","2020-01-14","2020-01-14","2020-01-27","2020-01-27","2020-01-27","2020-05-14","2020-06-24","2021-03-24","2021-03-24","2021-05-18"],"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":[["","65862050220","AMOX\/K","500-125","20","Select","Select",""],["","73070010315","INSULIN","FLEXPEN","15","Select","Select",""],["","00169633910","NOVOLOG","FLEXPEN","15","Select","Select",""],["","00088221905","LANTUS","100\/ML","9","Select","Select",""],["","99073012050","FREESTYLE TES","","200","Select","Select",""],["","99073013001","FREESTYLE MIS LANCETS","LANCETS","200","Select","Select",""],["","99073070805","FREESTYLE MIS LITE","LITE","1","Select","Select",""],["","99073070827","FREESTYLE TES LITE","LITE","200","Select","Select",""],["","08290320550","BD PEN NEEDL","32GX5\/32","100","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","68180051303","LISINOPRIL","5MG","30","Select","Select",""],["","65862086001","FAMOTIDINE","40MG","30","Select","Select",""],["","65862050220","AMOX\/K ","TAB 500-125","20","Select","Select",""],["","73070010315","INSULIN ","INJ FLEXPEN","15","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","15","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","9","Select","Select",""],["","99073012050","FREESTYLE    TES","TES ","200","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","200","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","200","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","68180051303","LISINOPRIL ","TAB 5MG","30","Select","Select",""],["","65862086001","FAMOTIDINE ","TAB 40MG","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":[[["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":""}]}]}