{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RAVEN   L HART","gend":1,"add":"5506   CALEDON ROAD                                         ","city":"KING GEORGE                   ","state":"VA","zip":"22485-7537","dob":"1992-05-13","age":"","mstatus":"","insh":10049160,"cliId":"","pno":5403610736,"cno":5403610736,"email":"","ename":"","eno":"","pphy":"ANSARI, NATHER B                                            ","ppno":"","pcpadd":"1075 GARRISONVILLE RD","pcpcity":"STAFFORD                      ","pcpstate":"VA","pcpzip":225568600,"pcpcounty":"","pcpid":"P0125879","pcpname":"SENIOR AND ADULT CARE LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"5506   CALEDON ROAD                                         ","madd2":"                                                            ","madd3":"","mcity":"KING GEORGE                   ","mstate":"VA","mzip":"22485-7537","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J01.00","B37.3","Z32.00","R10.33","N91.2","Z32.02","Z11.3","R10.2","R10.30","R94.5","R68.89","N76.0","N92.5","R03.0","F32.9","F41.9","F41.3","R63.5","R53.83","Z76.89","N39.0","N91.1","F33.9","F34.1","F41.1","F39","F81.9","R35.0","R10.10","R31.21","B96.89","E78.49","J01.91","R52","R51","B37.9","J01.90","R59.1","E66.9","Z01.419","Z12.39","Z30.09","J01.01","R09.81","N89.8","K04.7","Z76.0","N30.01","R30.0","Z20.2","A59.01"],"date":["2020-01-30","2021-10-08","2021-07-26","2019-02-08","2019-02-14","2019-02-25","2021-10-08","2019-02-14","2019-02-25","2019-02-19","2020-12-17","2021-10-08","2019-04-15","2019-04-15","2019-05-02","2021-09-16","2019-05-08","2019-09-27","2019-05-08","2019-05-08","2021-03-24","2019-06-07","2019-06-07","2019-08-08","2019-08-08","2021-09-16","2021-09-16","2021-07-26","2019-09-27","2019-09-27","2021-10-08","2019-09-27","2019-12-02","2020-01-30","2020-01-30","2020-01-30","2020-09-11","2020-02-09","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2020-03-13","2020-03-13","2020-09-11","2021-04-09","2021-03-24","2021-07-26","2021-07-26","2021-07-26","2021-10-08"],"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":[["","60505283403","ATOMOXETINE","60MG","30","Select","Select",""],["","13668013701","ESCITALOPRAM","20MG","45","Select","Select",""],["","43547030503","ARIPIPRAZOLE","15MG","30","Select","Select",""],["","42806016105","HYDROXYZ","50MG","90","Select","Select",""],["","51991029401","OXCARBAZEPIN","600MG","60","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","51672404801","CLOTRIM\/BETA","DIPROP","15","Select","Select",""],["","00378334053","XULANE","150-35","3","Select","Select",""],["","24658031205","DOXYCYCL","100MG","10","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","69097012403","TOPIRAMATE","100MG","60","Select","Select",""],["","00093117410","PENICILLN","500MG","28","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","49483060450","IBUPROFEN","800MG","30","Select","Select",""],["","55111053401","DIVALPROEX","500MG ER","60","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","30","Select","Select",""],["","47781030301","NITROFURANTN","100MG","10","Select","Select",""],["","00143992801","CIPROFLOXACN","500MG","20","Select","Select",""],["","50111064801","FLUOXETINE","20MG","60","Select","Select",""],["","68180012101","CEPHALEXIN","250MG","40","Select","Select",""],["","45802057178","FEXOFENADINE","180MG","30","Select","Select",""],["","60505283403","ATOMOXETINE ","CAP 60MG","30","Select","Select",""],["","13668013701","ESCITALOPRAM ","TAB 20MG","45","Select","Select",""],["","43547030503","ARIPIPRAZOLE ","TAB 15MG","30","Select","Select",""],["","42806016105","HYDROXYZ ","TAB 50MG","90","Select","Select",""],["","55111014512","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","51991029401","OXCARBAZEPIN ","TAB 600MG","60","Select","Select",""],["","51672404801","CLOTRIM\/BETA ","CRE DIPROP","15","Select","Select",""],["","00378334053","XULANE ","DIS 150-35","3","Select","Select",""],["","24658031205","DOXYCYCL ","TAB 100MG","10","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","69097012403","TOPIRAMATE ","TAB 100MG","60","Select","Select",""],["","00093117410","PENICILLN ","TAB 500MG","28","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","55111053401","DIVALPROEX ","TAB 500MG ER","60","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","50111064801","FLUOXETINE ","CAP 20MG","60","Select","Select",""],["","68180012101","CEPHALEXIN ","CAP 250MG","40","Select","Select",""],["","45802057178","FEXOFENADINE ","TAB 180MG","30","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":""}]}]}