{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" MALKA HUSSEIN","gend":1,"add":"1617 HOPE RD.","city":"GLEN ALLEN","state":"VA","zip":"23060-4210","dob":"1959-08-30","age":"","mstatus":"","insh":10049173,"cliId":"","pno":"8045508140, 8045508140","cno":"","email":"","ename":"","eno":"","pphy":"SHUKLA, ANJALI HEMANT","ppno":"               ","pcpadd":"9600 PATTERSON AVENUE, ","pcpcity":"HENRICO","pcpstate":"VA","pcpzip":232296053,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"APARTMENT B","add3":"","madd1":"10311 Leander Drive","madd2":"                                                            ","madd3":"","mcity":"GLEN ALLEN","mstate":"VA","mzip":"23060-4210","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","N18.6","D50.9","D63.1","Z99.2","H25.812","Z96.1","H04.123","E11.3393","D31.31","R92.8","R51","R29.898","Q61.2","Z76.82","I70.0","E66.01","G89.18","R10.9","Q61.3","E87.1","E16.2","R41.82","R60.9","Z98.890","I16.1","I21.4","R51.9","I10","R00.2","E87.79","R07.9","R68.89","Z48.22","E11.65","E78.5","I12.9","E11.22","N18.9","Z94.0","G47.33","I12.0","K59.00","Z79.4","Z79.899","Z79.84","M71.21","M25.461","M17.10","Z68.38","E04.9","E21.3","N39.0","I65.22","Z95.820","Z86.73","E78.00","I42.9","Z79.82","K76.0","Z23","Z68.41","D63.8","R73.03","M54.16","M54.41","R42","E11.9","Z87.442","M47.26","Z01.419","R94.31","Z45.2","T82.838A","N25.81","R18.8","D64.9","H25.12","M25.561","Z12.31","M25.551","R20.0","R31.9","H40.053","M54.5","N28.1","N28.81","R09.02","E11.649","R47.81","R40.4","R77.8","Z11.59","Z48.816","Z48.02","Z90.5","M47.22","M62.838","I51.7","R00.0","T86.19","E87.5","B19.20","E87.70","Y83.0","E08.9","Z20.828","Z68.37","Z83.3","Z01.810","B25.9","D84.821","Z51.81","G62.9","Z68.39","K83.9","R10.11","M16.11","E11.3293","G93.41","R40.2132","R40.2242","R40.2352","E66.9","M54.6","K29.30","K31.89","M17.0","M21.6X2","M21.6X1","M77.50","E11.42","R60.0","B35.1","M47.816","R87.610","I49.3","R10.31","K91.31","K66.0","M48.02","R91.8","Z48.01","Z79.52","E09.9","T38.0X5A","I51.89","K29.70","I13.2","I50.32","K83.8","K86.9","I45.9","R53.1","I48.0","Z01.818","T82.898A","Z20.5","N18.4","E03.9","K31.7","K29.50","H25.811","K21.9","E84.8","J06.9","J02.9","R55","F99","F03.90","Z49.02","Z09","F51.5","R44.1","I21.A1","J96.91","J96.92","I13.11","F41.9","K59.09"],"date":["2021-03-29","2021-05-17","2020-06-01","2020-10-15","2020-10-13","2020-03-16","2021-05-19","2021-03-26","2019-08-27","2020-03-16","2019-08-28","2019-10-02","2019-10-02","2021-01-18","2020-02-27","2020-02-27","2020-11-25","2020-04-23","2020-04-29","2020-04-30","2020-10-13","2020-05-02","2020-04-29","2020-04-30","2020-04-29","2020-10-16","2020-10-16","2020-10-13","2021-03-10","2020-10-13","2020-10-15","2020-10-14","2020-10-17","2021-05-17","2020-11-05","2021-05-17","2021-04-16","2021-05-17","2021-04-16","2021-05-14","2021-03-12","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2020-12-21","2019-04-10","2019-04-10","2019-04-10","2019-04-10","2019-09-19","2019-09-19","2019-10-01","2019-10-02","2019-10-01","2020-11-04","2020-04-29","2020-04-29","2019-10-01","2019-10-01","2019-10-16","2020-11-04","2020-02-17","2020-02-17","2019-10-16","2019-10-16","2019-11-05","2020-12-21","2019-11-05","2020-02-17","2020-03-04","2020-10-25","2020-10-26","2020-09-02","2020-10-06","2020-10-26","2021-04-16","2021-03-26","2019-04-10","2019-08-23","2019-09-26","2019-10-02","2019-10-01","2019-10-08","2019-11-15","2020-04-22","2020-04-22","2020-04-22","2020-04-29","2020-04-22","2020-04-22","2020-04-29","2021-05-14","2020-05-13","2020-05-13","2020-05-18","2020-10-02","2020-10-02","2020-10-26","2020-10-13","2020-12-21","2020-10-25","2020-10-25","2020-10-25","2020-10-25","2020-10-25","2020-10-25","2020-10-25","2020-10-25","2020-10-25","2020-12-21","2021-04-16","2020-12-21","2019-01-29","2019-06-14","2019-05-20","2019-05-20","2019-09-26","2020-03-16","2020-04-29","2020-04-29","2020-04-29","2020-04-29","2020-10-26","2020-10-02","2019-01-03","2019-01-03","2020-10-01","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2020-01-14","2020-01-20","2020-03-04","2020-04-23","2020-10-01","2020-10-01","2020-10-01","2020-10-02","2020-10-26","2020-11-04","2020-11-04","2021-03-10","2021-03-10","2021-03-10","2019-01-03","2019-01-03","2019-01-03","2019-01-10","2019-01-10","2019-01-30","2019-10-02","2020-01-20","2020-03-20","2020-05-08","2020-12-11","2019-01-03","2019-01-03","2019-01-03","2019-01-03","2019-02-13","2019-02-13","2019-02-13","2019-06-04","2019-06-04","2019-11-05","2020-03-05","2020-03-05","2020-04-23","2020-05-18","2020-05-18","2020-05-18","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13"],"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":[["","43547040111","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","68645048154","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","45963043963","CONSTULOSE ","SOL 10GM\/15","900","Select","Select",""],["","50742062201","NIFEDIPINE ","TAB 90MG ER","60","Select","Select",""],["","68382009405","CARVEDILOL ","TAB 12.5MG","120","Select","Select",""],["","16729026129","MYCOPHENOLIC ","TAB 180MG DR","180","Select","Select",""],["","67877022310","GABAPENTIN ","CAP 300MG","30","Select","Select",""],["","65862007930","TERBINAFINE ","TAB 250MG","15","Select","Select",""],["","00172572860","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","65862075360","VALGANCICLOV ","TAB 450MG","30","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","30","Select","Select",""],["","00603533815","PREDNISONE ","PAK 10MG","21","Select","Select",""],["","65162027150","SMZ-TMP ","TAB 400-80MG","30","Select","Select",""],["","00093735201","CALCITRIOL ","CAP 0.25MCG","30","Select","Select",""],["","00054418425","DEXAMETHASON ","TAB 4MG","18","Select","Select",""],["","29300013701","CLONIDINE ","TAB 0.3MG","90","Select","Select",""],["","00002879959","HUMALOG ","INJ 100\/ML","15","Select","Select",""],["","00603020922","MAG ","TAB 400MG","60","Select","Select",""],["","45802005635","GENTAMICIN ","CRE 0.001","15","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","12","Select","Select",""],["","31722070290","LOSARTAN ","TAB 100MG","90","Select","Select",""],["","59922063101","AURYXIA ","TAB 210MG","240","Select","Select",""],["","55513007330","SENSIPAR ","TAB 30MG","30","Select","Select",""],["","00536105224","PEG3350 ","POW ","238","Select","Select",""],["","65162062710","TRAMADOL ","TAB 50MG","5","Select","Select",""],["","68180044501","QUETIAPINE ","TAB 25MG","30","Select","Select",""],["","68645057454","GLIPIZIDE ","TAB 5MG","60","Select","Select",""],["","50383066730","LIDO\/PRILOCN ","CRE 2.5-2.5%","30","Select","Select",""],["","68645051654","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","00406012401","HYDROCO\/APAP ","TAB 7.5-325","25","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","16729004201","TACROLIMUS ","CAP 1MG","120","Select","Select",""],["","61314063715","PREDNISOLONE ","SUS 1% OP","10","Select","Select",""],["","00597015330","JARDIANCE ","TAB 25MG","30","Select","Select",""],["","62756014202","METFORMIN ","TAB 500MG ER","180","Select","Select",""],["","64980051505","OFLOXACIN ","DRO 0.3% OP","5","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","20","Select","Select",""],["","65862053650","LEVOFLOXACIN ","TAB 250MG","7","Select","Select",""],["","16714008210","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","45802086803","POLYETH ","POW 3350 NF","510","Select","Select",""],["","59746012206","MECLIZINE ","TAB 12.5MG","20","Select","Select",""],["","70000044703","SENNA ","TAB 8.6MG","180","Select","Select",""],["","65862050220","AMOX\/K ","TAB 500-125","14","Select","Select",""],["","45802014167","CICLOPIROX ","SOL 0.08","6.6","Select","Select",""],["","50383077932","LACTULOSE ","SOL 10GM\/15","900","Select","Select",""],["","57896045401","GERI-KOT ","TAB 8.6MG","180","Select","Select",""],["","00121086816","NYSTATIN ","SUS 100000","200","Select","Select",""],["","70000050301","ACID ","TAB 20MG","30","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","00781569005","EZETIMIBE ","TAB 10MG","4","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","08222710031","PEN  NEEDLES  ","MIS 32GX4MM","100","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","57896092110","ASPIRIN ","TAB 325MG EC","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}