{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN DISTEFANO JR","gend":0,"add":"1093 CARTERSVILLE RD                                        ","city":"CUMBERLAND                    ","state":"VA","zip":"23027-9615","dob":"1970-05-15","age":"","mstatus":"","insh":10048621,"cliId":"","pno":4348083054,"cno":"","email":"","ename":"","eno":"","pphy":"BLACKWELL, BRIAN K                                          ","ppno":"","pcpadd":"25892 N James Madison Hwy,Ste A","pcpcity":"New Canton                    ","pcpstate":"VA","pcpzip":231232234,"pcpcounty":"","pcpid":"P9058488","pcpname":"CENTRAL VIRGINIA COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1093 CARTERSVILLE RD                                        ","madd2":"                                                            ","madd3":"","mcity":"CUMBERLAND                    ","mstate":"VA","mzip":"23027-9615","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.9","Z71.89","Z71.3","Z76.0","F17.210","Z79.899","F43.12","K52.9","R10.9","R11.2","R19.7","N20.0","K76.89","R10.84","R10.32","R52","F11.23","F19.939","Z88.0","R79.89","F32.9","F17.200","G89.29","I10","K40.90","K56.7","Z00.00","F30.9","F43.10","A41.9","S79.911A","R40.4","R53.1","R68.89","S06.0X9A","Y93.E1","W01.10XA","Y92.002","S09.90XA","S09.8XXA","G44.89","R51","J32.3","J32.2","M54.5","F11.20","G89.21","E87.2","K92.0","D64.9","E87.6","Z82.49","Z83.3","Z87.19","Z86.010","Z20.828","R50.81","R23.2","F13.20","R07.9","R91.1","I45.10","N39.0","R00.2","K57.92","R07.89","R00.1","M62.81","F33.1","F41.1","Z91.410","B34.9","Z20.822","K59.03","F11.10","R05","T50.905A"],"date":["2020-05-19","2019-06-13","2019-06-13","2019-06-29","2020-12-18","2020-04-23","2020-04-23","2019-02-12","2019-06-19","2019-02-12","2019-02-12","2020-10-30","2019-02-12","2019-02-12","2019-02-12","2019-02-12","2020-12-18","2019-03-11","2019-06-29","2019-03-11","2020-04-23","2019-03-12","2019-07-10","2020-12-18","2019-04-20","2019-04-20","2019-06-13","2019-06-13","2020-05-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-06-29","2019-06-29","2019-06-29","2019-07-10","2020-05-29","2020-01-30","2020-04-23","2020-04-23","2020-04-23","2020-04-23","2020-04-23","2020-04-23","2020-04-23","2020-04-23","2020-04-24","2020-04-24","2020-04-24","2020-05-19","2021-01-03","2020-06-01","2020-10-30","2020-10-30","2020-12-05","2020-10-30","2020-12-05","2020-12-05","2020-12-05","2020-12-18","2020-12-18","2020-12-18","2021-01-03","2021-01-03","2021-01-03","2021-01-03","2021-01-03","2021-01-03"],"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":[["","00093083205","CLONAZEPAM","0.5MG","90","Select","Select",""],["","68180098003","LISINOPRIL","10MG","30","Select","Select",""],["","59651017401","DOXEPIN","25MG","180","Select","Select",""],["","68382003516","VENLAFAXINE","75MG ER","90","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","37000045502","PRILOSEC","20MG","10","Select","Select",""],["","57237011490","ALFUZOSIN","10MG ER","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","13668033201","TRAZODONE","150MG","90","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","00228212710","CLONIDINE","0.1MG","10","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","10","Select","Select",""],["","12496120803","SUBOXONE","8-2MG","10","Select","Select",""],["","00172392670","DIAZEPAM","5MG","4","Select","Select",""],["","43598075201","BUPROPION","150MG SR","30","Select","Select",""],["","13668042990","PANTOPRAZOLE","40MG","30","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","00093083205","CLONAZEPAM ","TAB 0.5MG","90","Select","Select",""],["","59651017401","DOXEPIN ","CAP 25MG","180","Select","Select",""],["","68382003516","VENLAFAXINE ","CAP 75MG ER","90","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","37000045502","PRILOSEC ","TAB 20MG","10","Select","Select",""],["","57237011490","ALFUZOSIN ","TAB 10MG ER","30","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","13668033201","TRAZODONE ","TAB 150MG","90","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","14539067401","HYDROXYZ ","CAP 25MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00228212710","CLONIDINE ","TAB 0.1MG","10","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","10","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","4","Select","Select",""],["","43598075201","BUPROPION ","TAB 150MG SR","30","Select","Select",""],["","13668042990","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","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","",""],["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":""}]}]}