{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MEGHAN BEASLEY","gend":1,"add":"P.O BOX 592                                                 ","city":"MECHANICSVILLE                ","state":"VA","zip":"23111-0592","dob":"1984-10-22","age":"","mstatus":"","insh":10048340,"cliId":"","pno":8042479231,"cno":8042479231,"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":"                                                            ","add3":"","madd1":"P.O BOX 592                                                 ","madd2":"                                                            ","madd3":"","mcity":"MECHANICSVILLE                ","mstate":"VA","mzip":"23111-0592","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H53.033","J45.21","R09.89","Z87.891","R05","J02.9","J45.909","Z88.5","Z01.419","Z76.0","F90.9","Z13.29","R63.5","Z76.89","E04.9","E55.9","Z13.220","R73.02","Z68.28","R35.0","E78.00","J45.20","E66.3","F17.290","Z79.899","J45.901","Z30.9","J45.31","Z00.00","K44.9","R13.10","F17.210","Z79.51"],"date":["2019-01-11","2020-03-01","2020-08-06","2020-08-06","2020-11-15","2019-03-28","2019-06-25","2020-03-01","2020-07-16","2019-06-25","2019-06-25","2019-11-22","2020-09-29","2019-11-22","2019-11-27","2020-09-29","2019-11-22","2019-11-22","2019-12-06","2019-11-22","2020-03-01","2019-12-06","2019-12-06","2020-11-15","2020-11-15","2020-03-01","2020-07-16","2021-08-05","2020-09-29","2020-11-10","2020-11-10","2020-11-15","2020-11-15"],"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":[["","00487950160","ALBUTEROL","0.08%","75","Select","Select",""],["","45802012935","HALOBETASOL","0.05%","15","Select","Select",""],["","59762219801","AZITHROMYCIN","250MG","6","Select","Select",""],["","00591544210","PREDNISONE","10MG","21","Select","Select",""],["","00378334053","XULANE","150-35","9","Select","Select",""],["","16571040250","CETIRIZINE","10MG","30","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10.2","Select","Select",""],["","65162035803","ZAFEMY","150\/35","9","Select","Select",""],["","57237016805","ROSUVASTATIN","5MG","30","Select","Select",""],["","00093227534","AMOX\/K","875-125","14","Select","Select",""],["","00487950160","ALBUTEROL ","NEB 0.00083","75","Select","Select",""],["","45802012935","HALOBETASOL ","CRE 0.0005","15","Select","Select",""],["","59762219801","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00591544210","PREDNISONE ","TAB 10MG","21","Select","Select",""],["","00378334053","XULANE ","DIS 150-35","9","Select","Select",""],["","16571040250","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","65162035803","ZAFEMY ","DIS 150\/35","9","Select","Select",""],["","57237016805","ROSUVASTATIN ","TAB 5MG","30","Select","Select",""],["","00093227534","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","59762444002","METHYLPRED ","TAB 4MG","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":""}]}]}