{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THOMAS   C DAVIS","gend":0,"add":"11900 SHADY HILLS COURT","city":"GLEN ALLEN","state":"VA","zip":"23059-7037","dob":"1993-05-01","age":"","mstatus":"","insh":10048767,"cliId":"","pno":5713303521,"cno":5713303521,"email":"","ename":"","eno":"","pphy":"VCU CENTER FOR ADVANCED HEALTH","ppno":8042543500,"pcpadd":"MCV Physicians, 2116 W Laburnum Ave Ste 100","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232274359,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"11900 SHADY HILLS COURT","madd2":"                                                            ","madd3":"","mcity":"GLEN ALLEN","mstate":"VA","mzip":"23059-7037","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D83.0","I26.99","F84.0","F40.10","F33.1","Z79.899","D3A.010","D84.9","K31.89","K21.9","R12","R91.8","K90.0","R07.9","R10.9","R16.2","Z86.711","D83.9","J45.909","E03.9","E78.5","G47.00","E66.9","Z68.38","Z71.82","D3A.8","R07.89","Z90.49","Z79.01"],"date":["2021-04-13","2019-06-12","2021-05-06","2021-05-06","2021-05-06","2019-06-13","2019-08-22","2019-08-22","2019-08-06","2019-08-06","2019-08-06","2019-06-24","2019-04-24","2019-04-24","2019-05-22","2019-04-24","2020-01-22","2019-05-22","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2020-01-22","2020-01-22","2020-01-22","2020-01-22"],"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":[["","68180059206","DESVENLAFAX ","TAB 50MG ER","30","Select","Select",""],["","24658031205","DOXYCYCL ","TAB 100MG","28","Select","Select",""],["","64380076111","OMEGA-3-ACID ","CAP 1GM","60","Select","Select",""],["","51991029401","OXCARBAZEPIN ","TAB 600MG","60","Select","Select",""],["","13668000805","ZOLPIDEM ","TAB 10MG","15","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","50111043401","TRAZODONE ","TAB 100MG","270","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","00781185220","AMOX\/K ","TAB 875-125","28","Select","Select",""],["","00378181377","LEVOTHYROXIN ","TAB 125MCG","90","Select","Select",""],["","31604001870","VITAMIN ","TAB 1000UNIT","90","Select","Select",""],["","60505392701","GUANFACINE ","TAB 1MG ER","90","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","00093742698","MONTELUKAST ","TAB 10MG","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":""}]}]}