{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DERRICK   T FRAZIER","gend":0,"add":"3706   LAWSON STREET                                        ","city":"RICHMOND                      ","state":"VA","zip":"23224-1862","dob":"1964-02-04","age":"","mstatus":"","insh":10049142,"cliId":"","pno":8044779520,"cno":8044779520,"email":"","ename":"","eno":"","pphy":"VCU CENTER FOR ADVANCED HEALTH                              ","ppno":"","pcpadd":"MCV Physicians","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232274359,"pcpcounty":"","pcpid":"P0130488","pcpname":"VCU CENTER FOR ADVANCED HEALTH-SL","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"3706   LAWSON STREET                                        ","madd2":"                                                            ","madd3":"","mcity":"RICHMOND                      ","mstate":"VA","mzip":"23224-1862","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.40","F33.41","F60.2","F10.94","F33.1","F31.32","F33.2","F25.1","B35.6","R21","F17.200","I10","E55.9","E78.5","E03.9","E03.8","E78.49","J30.2"],"date":["2019-08-25","2019-07-01","2021-10-25","2021-10-25","2019-06-02","2019-05-21","2019-07-28","2021-10-01","2019-08-22","2019-08-22","2021-04-13","2021-05-11","2021-05-11","2021-04-21","2020-10-08","2020-07-24","2020-10-08","2021-04-13"],"priorHcc":["","","","","","","",null,"","","","","","","","","",""]}},{"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":[["","13668001105","CITALOPRAM","40MG","30","Select","Select",""],["","43547034106","RISPERIDONE","1MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","30","Select","Select",""],["","68001031508","LOVASTATIN","20MG","30","Select","Select",""],["","64380073706","VITAMIN","50000UNT","4","Select","Select",""],["","51991081701","PROPRANOLOL","60MG ER","30","Select","Select",""],["","69238183001","LEVOTHYROXIN","25MCG","30","Select","Select",""],["","50383070016","FLUTICASONE","50MCG","16","Select","Select",""],["","51660052601","ALLERGY","10MG","30","Select","Select",""],["","00536589488","NICOTINE","7MG\/24HR","14","Select","Select",""],["","69097083207","BENZTROPINE","2MG","30","Select","Select",""],["","00904671960","ACETAMINOPHE","325MG","20","Select","Select",""],["","65162046510","IBUPROFEN","600MG","20","Select","Select",""],["","00093768432","OLOPATADINE","0.20%","2.5","Select","Select",""],["","43547034106","RISPERIDONE ","TAB 1MG","90","Select","Select",""],["","13668001105","CITALOPRAM ","TAB 40MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","68001031508","LOVASTATIN ","TAB 20MG","30","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","51991081701","PROPRANOLOL ","CAP 60MG ER","30","Select","Select",""],["","69238183001","LEVOTHYROXIN ","TAB 25MCG","30","Select","Select",""],["","50383070016","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","51660052601","ALLERGY ","TAB 10MG","30","Select","Select",""],["","00536589488","NICOTINE ","DIS 7MG\/24HR","14","Select","Select",""],["","69097083207","BENZTROPINE ","TAB 2MG","30","Select","Select",""],["","00904671960","ACETAMINOPHE ","TAB 325MG","20","Select","Select",""],["","65162046510","IBUPROFEN ","TAB 600MG","20","Select","Select",""],["","00093768432","OLOPATADINE ","SOL 0.002","2.5","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":""}]}]}