{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" JIMMY J CARTER","gend":0,"add":"1108 THOMAS JEFFERSON PLACE","city":"FALMOUTH","state":"VA","zip":"22405-1640","dob":"1958-08-07","age":"","mstatus":"","insh":10048367,"cliId":"","pno":5408417684,"cno":"","email":"","ename":"","eno":"","pphy":"ALEXANDER, DAWN","ppno":"               ","pcpadd":"231 Garrisonville Rd, Ste 101","pcpcity":"Stafford","pcpstate":"VA","pcpzip":225541604,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1108 THOMAS JEFFERSON PLACE","madd2":"                                                            ","madd3":"","mcity":"FALMOUTH","mstate":"VA","mzip":"22405-1640","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.1","F43.21","E11.21","N18.9","N18.4","D63.1","N25.81","R60.9","I12.9","R53.81","E11.22","R80.8","R60.1","G47.33","E87.70","N18.3","E11.65","R06.02","F11.21","R68.89","I10","Z71.89","Z71.3","N18.6","R39.9","T82.590A","E03.9","G62.9","N39.41","N40.1","R26.89","R39.81","T82.858A","T82.848A","T82.838A","D50.9","Z99.2","E87.79","E11.9","I63.9","I50.32","U07.1","J12.89","R11.2","I12.0","B97.29","E11.40","M19.90","E11.51","G89.4","F41.9","N40.0","G25.81","G43.909","Z12.11","Z86.010","D12.3","D12.2","K62.1","K92.0","K31.89","Z86.16","Z86.73","Z87.891","E11.42","Z79.4","Z89.421","I50.9","E78.2","E11.69","E78.5","R11.10","R19.7","Z20.828","R07.9","N28.1","R10.84","R10.9","R91.8","K92.2","Z23","M79.641","N17.9","D72.829","E87.6","R80.9","I13.2","Z68.42","I25.10","T82.868A","T82.898A","Z49.01","I87.1","R69","Z01.812","Z20.822","E13.3293","K31.9","J96.21","F51.04","T82.598A","E11.52","G89.29","I69.354","I70.203","N19","R53.1","R60.0","F32.9","G47.39","E66.9","L85.3","I82.290","I82.C11","Z46.82","D12.5","R10.13","F39","N18.2","Z96.1","N18.5","Z68.43","E66.01","K59.00","F33.1","Z11.59","K94.21","R26.2","K63.5","Z01.810","R94.4","R04.2","R53.83","R11.0","K56.609","J96.01","N39.46","M30.0","R55","R05","R06.01","A41.89","J15.9","N12","E87.3","K56.7","D62","I13.11","E10.22","R41.3"],"date":["2019-02-07","2019-02-07","2021-04-30","2019-11-07","2020-08-20","2021-02-01","2021-02-01","2020-10-08","2021-01-26","2021-01-28","2020-09-04","2019-10-21","2021-02-01","2021-01-26","2021-02-01","2019-07-31","2020-10-29","2020-10-08","2019-09-10","2021-02-26","2021-03-23","2020-10-29","2020-10-29","2021-05-13","2020-01-30","2020-10-27","2020-07-08","2020-03-24","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2020-05-21","2020-05-21","2020-05-21","2021-02-01","2021-04-30","2021-02-01","2021-03-23","2020-12-01","2021-01-01","2021-01-01","2020-07-17","2020-07-21","2021-04-30","2020-07-21","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-02-16","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-03-16","2021-03-16","2021-03-16","2021-03-23","2020-10-29","2020-07-17","2020-07-08","2020-07-21","2020-07-17","2020-07-17","2020-07-17","2020-07-13","2020-07-13","2020-07-17","2021-04-05","2020-07-17","2020-10-29","2020-10-29","2019-11-12","2019-09-11","2019-09-11","2019-10-23","2019-11-07","2020-07-08","2021-04-05","2020-03-01","2020-02-03","2019-11-12","2020-10-27","2020-12-01","2021-01-25","2021-01-25","2021-02-11","2021-01-26","2019-08-02","2019-06-27","2020-02-18","2020-02-29","2020-02-29","2020-02-29","2020-05-21","2020-07-06","2020-07-06","2020-07-06","2019-09-10","2019-09-10","2019-09-10","2020-06-25","2020-02-18","2020-02-18","2020-07-12","2021-01-26","2021-01-26","2021-05-13","2019-03-08","2019-07-08","2019-08-01","2019-08-01","2019-08-01","2019-10-07","2019-08-29","2020-07-02","2020-07-18","2020-07-30","2021-02-16","2020-10-08","2021-04-01","2021-04-05","2019-09-10","2019-09-10","2020-07-17","2019-01-14","2019-06-27","2019-12-01","2020-03-12","2020-03-12","2020-03-12","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-10-27","2020-10-27","2021-05-19"],"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":[["","76385011250","CARVEDILOL ","TAB 12.5MG","60","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","00378180510","LEVOTHYROXIN ","TAB 75MCG","30","Select","Select",""],["","50111043401","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","36","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","53746051101","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","200","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","300","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","00527221637","METOLAZONE ","TAB 5MG","30","Select","Select",""],["","00193707025","CONTOUR ","TES BLD GLUC","100","Select","Select",""],["","45802086866","POLYETH ","POW 3350 NF","28","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","30","Select","Select",""],["","00185013001","BUMETANIDE ","TAB 2MG","60","Select","Select",""],["","70377003012","ATORVASTATIN ","TAB 80MG","90","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","180","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","30","Select","Select",""],["","60505009600","DOXAZOSIN ","TAB 8MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","48","Select","Select",""],["","50428054089","CVS ","CAP 5000UNIT","30","Select","Select",""],["","66758019001","KLOR-CON ","TAB 20MEQ ER","30","Select","Select",""],["","59651005290","EZETIMIBE ","TAB 10MG","30","Select","Select",""],["","13668001105","CITALOPRAM ","TAB 40MG","30","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","14","Select","Select",""],["","60258016001","RENA-VITE ","TAB ","30","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","300","Select","Select",""],["","00378104901","DOXEPIN ","CAP 10MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","13668013701","ESCITALOPRAM ","TAB 20MG","30","Select","Select",""],["","00904671980","ACETAMINOPHEN ","TA B 325","100","Select","Select",""],["","00054418625","DEXAMETHASON ","TAB 6MG","7","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","00093221001","SUCRALFATE ","TAB 1GM","120","Select","Select",""],["","57664064888","CHLORTHALID ","TAB 25MG","30","Select","Select",""],["","50428690111","GENTLE ","SUP 10MG","32","Select","Select",""],["","08290324912","INSULIN ","MIS 1ML\/31G","100","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}