{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTOPHER   L JOHNSON","gend":0,"add":"7282 COLD HARBOR RD APT 202                                 ","city":"MECHANICSVILLE                ","state":"VA","zip":"23111-5076","dob":"1982-05-29","age":"","mstatus":"","insh":10049359,"cliId":"","pno":8042775404,"cno":8042775404,"email":"","ename":"","eno":"","pphy":"VCU CENTER FOR ADVANCED HEALTH                              ","ppno":"","pcpadd":"MCV Physicians","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232274359,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"7282 COLD HARBOR RD APT 202                                 ","madd2":"                                                            ","madd3":"","mcity":"MECHANICSVILLE                ","mstate":"VA","mzip":"23111-5076","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.62","J06.9","J20.9","F31.9","Z87.891","Z87.898","R06.02","F17.210","F10.10","H91.90","R68.89","E78.5","K21.9","R73.03","R74.8","R00.0","E66.09","Z71.3","Z71.89","I10","L84","Z23","Z79.899","L50.9","Z76.89","K59.00","K59.09","R11.2","Z68.39","F79","F42.9","F90.2","F31.63","H90.3","F50.89","G47.33","F70","Z71.6","R63.2","E11.65","R73.9","F17.200","Z79.51","Z79.1","E11.69","E11.9","L85.9"],"date":["2021-09-30","2019-03-04","2019-03-13","2021-09-07","2019-03-13","2019-03-13","2019-03-13","2019-03-13","2021-01-29","2019-03-13","2020-10-15","2021-10-28","2021-10-28","2021-04-12","2021-01-08","2021-01-08","2020-02-04","2021-08-16","2021-04-12","2021-10-28","2020-02-04","2020-02-04","2021-08-13","2020-06-15","2020-12-02","2021-10-28","2020-12-04","2020-12-09","2020-12-09","2020-12-23","2021-01-29","2021-01-29","2020-12-23","2021-01-29","2021-01-08","2021-10-28","2021-09-14","2021-04-12","2021-10-28","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-10-28","2021-09-07","2021-10-28"],"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":[["","00093727098","PRAVASTATIN","80MG","90","Select","Select",""],["","67877041401","METFORMIN","750MG ER","30","Select","Select",""],["","68180049401","CLOMIPRAMINE","75MG","62","Select","Select",""],["","27241011703","FENOFIBRATE","160MG","31","Select","Select",""],["","51991064405","OMEPRAZOLE","40MG","31","Select","Select",""],["","55111016830","OLANZAPINE","20MG","31","Select","Select",""],["","00193731221","CONTOUR","NEXT","100","Select","Select",""],["","00006027754","JANUVIA","100MG","7","Select","Select",""],["","56151014401","TRUPLUS","30G","100","Select","Select",""],["","16714048501","DIVALPROEX","500MG ER","60","Select","Select",""],["","51991029301","OXCARBAZEPIN","300MG","1","Select","Select",""],["","50742061510","METOPROL","25MG ER","30","Select","Select",""],["","10702001150","HYDROXYZ","25MG","30","Select","Select",""],["","65862001205","SERTRALINE","50MG","30","Select","Select",""],["","60505014101","GLIPIZIDE","5MG","30","Select","Select",""],["","52937000120","VASCEPA","1GM","120","Select","Select",""],["","00093221001","SUCRALFATE","1GM","60","Select","Select",""],["","64679084703","METOPROLOL","50MG ER","31","Select","Select",""],["","59779044874","CVS","21MG\/24H","28","Select","Select",""],["","74312003849","FISH","1000MG","30","Select","Select",""],["","68462010530","ONDANSETRON","4MG","30","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","56151014401","TRUPLUS ","MIS 30G","100","Select","Select",""],["","00093727098","PRAVASTATIN ","TAB 80MG","90","Select","Select",""],["","67877041401","METFORMIN ","TAB 750MG ER","30","Select","Select",""],["","68180049401","CLOMIPRAMINE ","CAP 75MG","62","Select","Select",""],["","27241011703","FENOFIBRATE ","TAB 160MG","31","Select","Select",""],["","51991064405","OMEPRAZOLE ","CAP 40MG","31","Select","Select",""],["","55111016830","OLANZAPINE ","TAB 20MG","31","Select","Select",""],["","00006027754","JANUVIA ","TAB 100MG","7","Select","Select",""],["","72060014230","CAPLYTA ","CAP 42MG","3","Select","Select",""],["","16714048501","DIVALPROEX ","TAB 500MG ER","60","Select","Select",""],["","68382056510","METOPROL ","TAB 50MG ER","30","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","60505014101","GLIPIZIDE ","TAB 5MG","30","Select","Select",""],["","52937000120","VASCEPA ","CAP 1GM","120","Select","Select",""],["","51991029301","OXCARBAZEPIN ","TAB 300MG","1","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","00093221001","SUCRALFATE ","TAB 1GM","60","Select","Select",""],["","64679084703","METOPROLOL ","TAB 50MG ER","31","Select","Select",""],["","59779044874","CVS ","DIS 21MG\/24H","28","Select","Select",""],["","74312003849","FISH ","CAP 1000MG","30","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","45802086803","POLYETH ","POW 3350 NF","510","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":""}]}]}