{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CONSTANCE   S JONES","gend":1,"add":"210 HOSPITAL STREET                                         ","city":"RICHMOND                      ","state":"VA","zip":"23219-1142","dob":"1960-01-14","age":"","mstatus":"","insh":10049419,"cliId":"","pno":8042033676,"cno":8049991843,"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":"APARTMENT 304                                               ","add3":"","madd1":"210 HOSPITAL STREET                                         ","madd2":"APARTMENT 304                                               ","madd3":"","mcity":"RICHMOND                      ","mstate":"VA","mzip":"23219-1142","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","R68.89","F25.9","F39","D70.9","R73.03","I10","E78.1","M17.11","E66.9","G89.29","M25.561","F17.210","M22.2X1","S83.001A","R60.9","J44.9","L60.9","Z12.31","I50.9","Z23","R07.9","B35.1","L85.3","R06.02","F19.11","D72.819","F31.9","R63.4","M54.5","Z79.899","M54.9","M79.674","R73.09","F17.200","Q80.9","R51","R53.1","H53.8","G62.9","L08.9","W57.XXXA","L02.414","L03.114","M19.022","S51.802D","M20.41","L97.411","L85.1","M20.42","B35.3","M79.675","L60.2","I51.7","R06.00","R26.89","B34.9","R05","F20.9","M54.2","F31.81","L30.9","J06.9","R40.0","M54.41","I73.9","M25.78","M47.816","M51.36","I49.3","I63.9","I16.1","I67.4","R47.02","R47.01","I11.0","E78.5","F40.240","K83.8","N64.4","Z79.82","Z82.49","Z20.822","Z79.51","R10.9","R41.82","R47.1","F41.9","F11.11","I65.23","R60.0","R06.01","I67.82","R41.0","R00.1","F11.10","Z71.6","I35.0","F10.10","T50.905A","G45.9","I95.9","Z01.30","G47.00","R20.2","R20.0","M79.603","F41.0","M19.90","Z86.73","R42"],"date":["2021-11-03","2021-02-27","2021-04-21","2020-05-18","2021-03-04","2019-03-29","2021-08-24","2021-08-10","2019-05-04","2019-04-18","2021-03-02","2019-05-04","2021-08-24","2019-05-09","2019-05-09","2021-06-28","2021-08-24","2019-10-10","2021-03-04","2021-08-24","2021-03-04","2021-06-28","2020-12-21","2019-10-10","2021-06-28","2019-12-31","2021-06-28","2021-06-29","2019-12-31","2019-12-31","2021-07-07","2021-05-12","2020-12-21","2020-02-10","2021-08-16","2020-11-02","2020-09-01","2021-06-30","2020-03-02","2020-11-02","2020-05-06","2020-05-06","2020-05-08","2020-05-09","2020-05-09","2020-05-11","2020-06-05","2020-10-09","2020-12-21","2020-06-05","2020-06-05","2020-12-21","2021-07-29","2021-06-30","2021-01-03","2020-07-05","2020-07-26","2020-07-26","2020-12-27","2021-05-12","2021-08-16","2021-03-02","2021-01-03","2021-03-02","2021-03-02","2021-06-30","2021-05-12","2021-05-12","2021-05-12","2021-06-28","2021-07-29","2021-06-28","2021-06-29","2021-06-28","2021-06-28","2021-08-24","2021-07-13","2021-06-28","2021-06-30","2021-06-28","2021-06-28","2021-08-24","2021-06-28","2021-06-28","2021-06-28","2021-06-30","2021-06-30","2021-08-24","2021-06-28","2021-06-30","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2021-06-30","2021-06-30","2021-07-01","2021-06-30","2021-08-10","2021-07-07","2021-07-13","2021-07-29","2021-08-10","2021-08-16","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-25"],"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":[["","70377002911","ATORVASTATIN","40MG","30","Select","Select",""],["","68180072103","AMLODIPINE","10MG","30","Select","Select",""],["","68180051703","LISINOPRIL","40MG","90","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10.2","Select","Select",""],["","42806016005","HYDROXYZ","25MG","15","Select","Select",""],["","57664050658","METOPROL","25MG","30","Select","Select",""],["","00378827052","ALBUTEROL","0.08%","150","Select","Select",""],["","45802041954","AMMONIUM","12%","225","Select","Select",""],["","00536113428","MICONAZOLE","2%","30","Select","Select",""],["","45802014167","CICLOPIROX","8%","6.6","Select","Select",""],["","00378021610","FUROSEMIDE","40MG","90","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","00603188016","LIDOCAINE","5%","30","Select","Select",""],["","43598029490","PREGABALIN","100MG","60","Select","Select",""],["","50111043301","TRAZODONE","50MG","1","Select","Select",""],["","13107015790","PAROXETINE","40MG","30","Select","Select",""],["","69097085902","TERBINAFINE","250MG","30","Select","Select",""],["","63304069201","CLINDAMYCIN","150MG","56","Select","Select",""],["","53746051501","SPIRONOLACT","100MG","60","Select","Select",""],["","43547034206","RISPERIDONE","2MG","30","Select","Select",""],["","33342032915","TRIAMCINOLON","0.10%","45","Select","Select",""],["","00597002402","COMBIVENT","20-100","4","Select","Select",""],["","50428047796","SKIN","12%","400","Select","Select",""],["","00536589688","NICOTINE","21MG\/24H","28","Select","Select",""],["","70436005901","BUPROPION","150MG SR","60","Select","Select",""],["","49884093547","DICLOFENAC","1%","100","Select","Select",""],["","00168005615","BETAMETH","0.05%","60","Select","Select",""],["","70954001910","PRAZOSIN","1MG","30","Select","Select",""],["","69097083412","SERTRALINE","50MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR","5MG","45","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","68180051703","LISINOPRIL ","TAB 40MG","90","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","42806016005","HYDROXYZ ","TAB 25MG","15","Select","Select",""],["","57664050658","METOPROL ","TAB 25MG","30","Select","Select",""],["","00378827052","ALBUTEROL ","NEB 0.00083","150","Select","Select",""],["","45802041954","AMMONIUM ","LOT 0.12","225","Select","Select",""],["","00536113428","MICONAZOLE ","CRE 0.02","30","Select","Select",""],["","45802014167","CICLOPIROX ","SOL 0.08","6.6","Select","Select",""],["","00378021610","FUROSEMIDE ","TAB 40MG","90","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","43598029490","PREGABALIN ","CAP 100MG","60","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","1","Select","Select",""],["","13107015790","PAROXETINE ","TAB 40MG","30","Select","Select",""],["","69097085902","TERBINAFINE ","TAB 250MG","30","Select","Select",""],["","63304069201","CLINDAMYCIN ","CAP 150MG","56","Select","Select",""],["","53746051501","SPIRONOLACT ","TAB 100MG","60","Select","Select",""],["","43547034206","RISPERIDONE ","TAB 2MG","30","Select","Select",""],["","33342032915","TRIAMCINOLON ","CRE 0.001","45","Select","Select",""],["","00597002402","COMBIVENT ","AER 20-100","4","Select","Select",""],["","50428047796","SKIN ","LOT 0.12","400","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","70436005901","BUPROPION ","TAB 150MG SR","60","Select","Select",""],["","49884093547","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","00168005615","BETAMETH ","OIN 0.0005","60","Select","Select",""],["","70954001910","PRAZOSIN ","CAP 1MG","30","Select","Select",""],["","69097083412","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR ","TAB 5MG","45","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":""}]}]}