{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ORLANDO BRADSHAW","gend":0,"add":"138   CENTER STREET                                         ","city":"EMPORIA                       ","state":"VA","zip":"23847-2154","dob":"1988-06-08","age":"","mstatus":"","insh":10048276,"cliId":"","pno":7578071690,"cno":7578071690,"email":"","ename":"","eno":"","pphy":"ANDERSON, MICHAEL S","ppno":"","pcpadd":"6 Doctors Dr","pcpcity":"Emporia                       ","pcpstate":"VA","pcpzip":238471240,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"APT D                                                       ","add3":"","madd1":"138   CENTER STREET                                         ","madd2":"APT D                                                       ","madd3":"","mcity":"EMPORIA                       ","mstate":"VA","mzip":"23847-2154","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.9","F39","Z91.14","F17.200","S30.812A","G89.11","W22.8XXA","Y93.9","Y92.002","F17.210","F20.89","Z11.3","Z20.2","Z79.899","E87.6","F41.9","F32.9","R68.89","E86.0","R55","N39.0","Z72.0","R42","R61","Z00.00","F33.2","F33.9","Z13.89","F25.0","Z51.81","F33.1","M62.81","R07.82","R53.1","R06.02","Z03.89","K05.6","K08.89","Z13.6","Z63.4","Z20.822","Z02.2"],"date":["2021-07-22","2019-01-04","2019-01-04","2019-08-02","2019-01-30","2019-01-30","2019-01-30","2019-01-30","2019-01-30","2021-07-22","2019-08-02","2019-03-15","2019-03-15","2021-07-22","2019-04-05","2019-04-05","2020-07-20","2019-04-05","2019-06-23","2020-03-16","2019-06-23","2020-03-16","2019-06-23","2019-08-03","2019-08-03","2019-08-18","2019-08-12","2019-08-12","2020-06-21","2019-08-14","2020-11-09","2020-03-16","2020-03-16","2020-03-16","2020-03-16","2020-03-16","2020-04-17","2020-04-17","2020-07-20","2020-10-07","2021-07-22","2021-07-22"],"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":[["","69315013601","BENZTROPINE","0.5MG","30","Select","Select",""],["","65862001330","SERTRALINE","100MG","30","Select","Select",""],["","68382007901","HALOPERIDOL","5MG","30","Select","Select",""],["","00093117410","PENICILLN","500MG","40","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","69315013601","BENZTROPINE ","TAB 0.5MG","30","Select","Select",""],["","65862001330","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","68382007901","HALOPERIDOL ","TAB 5MG","30","Select","Select",""],["","00093117410","PENICILLN ","TAB 500MG","40","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","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","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}