{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FLOYD   C CRAWFORD","gend":0,"add":"4309 2ND STREET","city":"RICHMOND","state":"VA","zip":"23223-5503","dob":"1972-05-09","age":"","mstatus":"","insh":10048783,"cliId":"","pno":8042057627,"cno":8049293030,"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":"4309 2ND STREET","madd2":"                                                            ","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23223-5503","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.40","E66.2","E11.21","Z13.31","Z79.4","Z00.00","E11.42","I10","I89.0","I87.2","K21.9","Z99.81","Z79.01","Z91.81","G89.4","D48.5","J98.4","Z68.44","F41.1","F32.9","R91.1","Z86.711","J96.22","Z99.11","E11.9","E66.01","R06.02","Z91.09","E08.42","G95.9","K59.01","K64.9","I45.81","R94.31","E11.51","L97.119","L97.129","L97.819","Z48.00","E11.622","L97.122","L97.112","E78.5","G47.00","L03.119","R05","R25.3","R07.89","R68.84","R51","E78.00","Z86.718","Z87.442","Z71.3","Z88.5","Z88.8","R07.9","R60.1","I95.1","I27.20","E11.49","R20.2","E78.2","D64.9","R53.83","E87.5","R31.21","S89.91XA","E11.65","E87.6","R31.9","L97.911","R46.0","L97.329","L97.319","L97.229","L97.921","E11.41","B37.7","Z01.89","L03.115","S81.802A","G47.33","J96.00","Z09","B37.2","Z68.43","G47.30","Z68.45","L97.811","L97.821","F41.9","Z68.30","Z11.59","R39.89","R10.9","R10.84","J11.1","Z71.89","L91.9","S91.201A","R09.81","J18.9","R11.2","R93.89","L89.212","M79.605","M79.604","S81.801A","L89.222","X58.XXXA","E08.41","L89.323","S80.821A","S91.002A","J30.81","J30.1","K59.00","M54.9","I26.92","Z20.828","R06.2","M89.9","E87.1","J96.10","E11.22","N18.9","S81.811A","L02.416","E11.628","G89.29"],"date":["2021-03-10","2021-05-18","2020-11-17","2019-01-04","2021-05-18","2021-03-12","2021-05-18","2021-05-18","2020-11-09","2020-11-09","2020-11-09","2021-04-19","2020-06-18","2019-02-01","2021-03-12","2019-02-27","2021-03-10","2021-03-09","2020-10-02","2020-10-02","2019-07-01","2021-03-10","2020-11-24","2020-11-24","2020-10-01","2021-05-18","2021-05-11","2021-05-18","2020-06-15","2021-03-12","2020-08-31","2020-08-31","2020-07-03","2020-07-03","2020-11-09","2020-11-09","2020-10-02","2020-11-09","2020-11-09","2021-03-09","2021-01-05","2021-03-18","2021-03-10","2021-03-10","2021-01-30","2019-03-20","2019-03-19","2019-09-05","2019-08-05","2019-08-05","2020-11-09","2021-03-01","2020-06-25","2019-08-05","2019-08-05","2019-08-05","2019-08-05","2019-09-05","2019-09-05","2019-09-05","2020-04-29","2020-04-29","2020-06-02","2021-03-18","2020-06-02","2020-12-14","2020-06-02","2020-06-02","2020-06-12","2020-06-12","2020-11-30","2021-01-18","2021-02-18","2021-03-18","2021-03-18","2021-03-18","2021-01-18","2021-05-18","2020-11-09","2021-03-12","2021-03-10","2020-11-12","2020-11-10","2020-11-10","2020-11-17","2020-11-24","2021-01-05","2021-03-10","2021-03-12","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-18","2019-01-25","2019-01-25","2019-01-25","2019-03-08","2021-03-18","2020-05-06","2019-12-17","2019-12-17","2020-05-20","2020-05-20","2020-05-20","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-07-01","2020-07-08","2020-07-01","2020-07-01","2021-05-18","2021-05-18","2020-10-02","2020-10-02","2020-05-05","2020-05-16","2020-05-16","2020-05-16","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2021-01-14","2021-02-16","2021-02-16","2021-03-18"],"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":[["","63824000834","MUCINEX ","TAB 600MG ER","60","Select","Select",""],["","00574200802","NYSTOP ","POW 100000","60","Select","Select",""],["","50484032400","SECURA ","CRE 0.306","92","Select","Select",""],["","62559043130","HYDROCORTISO ","CRE 0.025","30","Select","Select",""],["","42543005263","NYSTATIN ","POW 100000","120","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","9","Select","Select",""],["","00193708050","CONTOUR ","TES BLD GLUC","150","Select","Select",""],["","54162000708","SENNA-GRX ","SYP 8.8MG\/5","237","Select","Select",""],["","27808003702","HYDROCO\/APAP ","TAB 10-325MG","120","Select","Select",""],["","00169750111","NOVOLOG ","INJ 100\/ML","40","Select","Select",""],["","59746021605","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","46122041660","GNP ","TAB 600MG","60","Select","Select",""],["","00002771559","BASAGLAR ","INJ 100UNIT","12","Select","Select",""],["","27241009990","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","43547035611","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","00054429931","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","67877046590","PREGABALIN ","CAP 100MG","90","Select","Select",""],["","00054001829","PREDNISONE ","TAB 20MG","6","Select","Select",""],["","68382009405","CARVEDILOL ","TAB 12.5MG","60","Select","Select",""],["","51645091999","VITAMIN ","TAB 1000UNIT","30","Select","Select",""],["","00603616032","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","68382012305","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","70010006510","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","67618020016","BETASEPT ","LIQ 0.04","473","Select","Select",""],["","27241001709","MONTELUKAST ","CHW 5MG","30","Select","Select",""],["","24385049071","ALL ","TAB 220MG","30","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","08496311601","INSULIN ","MIS 1ML\/31G","100","Select","Select",""],["","42571016201","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","62175089241","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00071101568","LYRICA ","CAP 100MG","90","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","65162066490","RANITIDINE ","SYP 15MG\/ML","473","Select","Select",""],["","57237007730","ONDANSETRON ","TAB 4MG ODT","30","Select","Select",""],["","59762330403","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","00904645780","DOK ","CAP 100MG","60","Select","Select",""],["","00113030602","CLEARLAX ","POW ","238","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","14","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","4","Select","Select",""],["","10135014201","ASCORBIC ","TAB 500MG","7","Select","Select",""],["","67405060403","FLUCONAZOLE ","TAB 200MG","20","Select","Select",""],["","57237004390","VALACYCLOVIR ","TAB 1GM","14","Select","Select",""],["","70710101002","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","67877057301","BENZONATATE ","CAP 100MG","20","Select","Select",""],["","53746027205","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","86227013085","SURE ","MIS 32GX5\/32","200","Select","Select",""],["","21922002107","PERMETHRIN ","CRE 0.05","60","Select","Select",""],["","67877021660","CEFUROXIME ","TAB 500MG","14","Select","Select",""],["","51672131200","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","69367016204","PHENAZOPYRID ","TAB 100MG","20","Select","Select",""],["","00113949078","NAPROXEN ","TAB 220MG","60","Select","Select",""],["","16571041305","CIPROFLOXACN ","TAB 750MG","14","Select","Select",""],["","00904628909","SENNA ","SYP 8.8MG\/5","237","Select","Select",""],["","00143314205","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","65862017601","PENICILLN ","TAB 500MG","40","Select","Select",""],["","68462039610","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","00168008031","HYDROCORT ","CRE 0.025","30","Select","Select",""],["","57896040110","DOCUSATE ","CAP 100MG","60","Select","Select",""],["","68382070718","DOXYCYC ","CAP 100MG","20","Select","Select",""],["","46287000660","SPS ","SUS 15GM\/60","120","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","",""],["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":""}]}]}