{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TONIE CARPENTER","gend":1,"add":"619 N LABURNUM AVENUE","city":"HENRICO","state":"VA","zip":"23223-2875","dob":"1975-12-25","age":"","mstatus":"","insh":10048482,"cliId":"","pno":8046776875,"cno":3475081982,"email":"","ename":"","eno":"","pphy":"SHEEHAN, MICHAEL DALE","ppno":8042262444,"pcpadd":"4620 S Laburnum Ave, ","pcpcity":"Henrico","pcpstate":"VA","pcpzip":232312424,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":3475081982,"add2":"APT 1","add3":"","madd1":"619 N Laburnum Ave Apt 1","madd2":"                                                            ","madd3":"","mcity":"Richmond","mstate":"VA","mzip":"23223-2875","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","F33.2","F10.20","J45.31","B20","Z30.9","E55.9","Z98.84","I10","J45.20","S91.311A","S82.51XA","Z51.81","F06.31","F41.9","G89.18","S82.891S","S82.51XD","S91.011D","S91.311D","J45.909","G43.909","Z79.01","Z72.0","Z91.81","S82.841D","Z11.1","Z11.3","R94.31","S82.54XB","F32.2","J45.901","Z30.42","J30.2","G89.29","Z32.02","S82.51XB","Z48.01","S91.001A","Z09","F33.1","T78.40XA","S82.54XD","S91.301A","J01.00","S82.61XD","S96.921A","V03.10XA","T14.90XA","R52","K21.9","L40.9","Z48.89","M79.7","M48.00","R20.2","E66.9","Z68.36","Z21","X50.1XXA","Z96.653","M54.9","Z01.818","J32.9"],"date":["2020-09-22","2021-01-17","2020-08-30","2021-03-09","2021-03-09","2020-03-19","2020-09-08","2020-03-19","2021-03-09","2020-09-08","2020-07-28","2020-07-28","2020-08-14","2021-03-09","2019-08-14","2020-08-06","2020-08-06","2020-09-22","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-22","2021-03-09","2021-03-09","2020-07-28","2020-07-29","2021-01-15","2019-08-04","2019-09-24","2019-09-24","2020-09-08","2020-03-19","2020-07-29","2020-09-02","2020-09-02","2020-09-22","2021-04-18","2021-05-06","2020-08-06","2020-08-06","2019-02-22","2020-07-28","2020-07-28","2020-07-28","2020-08-06","2020-08-06","2020-09-08","2020-09-08","2020-09-10","2019-04-17","2019-04-17","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2021-03-09"],"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":[["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","61958210101","ODEFSEY ","TAB ","30","Select","Select",""],["","31722072690","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","50111043302","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","59762453701","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","60","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","42","Select","Select",""],["","00186037220","SYMBICORT ","AER 80-4.5","10.2","Select","Select",""],["","65162010250","GABAPENTIN ","CAP 300MG","180","Select","Select",""],["","00406048410","APAP\/CODEINE ","TAB 300-30MG","60","Select","Select",""],["","68382013805","TOPIRAMATE ","TAB 25MG","60","Select","Select",""],["","00591544210","PREDNISONE ","TAB 10MG","7","Select","Select",""],["","67877025145","TRIAMCINOLON ","CRE 0.001","454","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","21","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","33332031901","AFLURIA ","INJ 2019-20","0.5","Select","Select",""],["","00406012405","HYDROCO\/APAP ","TAB 7.5-325","28","Select","Select",""],["","49884031591","RISPERIDONE ","TAB 1MG ODT","28","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","00781577626","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00955100310","ENOXAPARIN ","INJ 30\/0.3ML","16.8","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","90","Select","Select",""],["","00363013830","SENNA ","ABL ETS","20","Select","Select",""],["","13107000130","MIRTAZAPINE ","7.5MG","90","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":""}]}]}