{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AKAL   B MANGAR","gend":0,"add":"10501 SERVO DRIVE                                           ","city":"GLEN ALLEN                    ","state":"VA","zip":"23060-4493","dob":"1949-04-11","age":"","mstatus":"","insh":10049506,"cliId":"","pno":8049670543,"cno":8049670543,"email":"","ename":"","eno":"","pphy":"VCU CENTER FOR ADVANCED HEALTH                              ","ppno":"","pcpadd":"MCV Physicians,Ste B","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232274359,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"10501 SERVO DRIVE                                           ","madd2":"                                                            ","madd3":"","mcity":"GLEN ALLEN                    ","mstate":"VA","mzip":"23060-4493","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","E03.9","J44.9","E55.9","R73.02","Z23","Z68.29","H25.13","H10.9","J30.1","M54.5","G89.29","Z11.59","H10.13","K08.89"],"date":["2021-08-27","2021-08-27","2021-08-27","2021-08-27","2019-04-17","2019-04-17","2021-01-11","2019-04-22","2019-04-22","2021-01-11","2021-08-27","2021-08-27","2021-01-11","2021-01-11","2021-08-27"],"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":[["","69618001001","ACETAMIN","325MG","60","Select","Select",""],["","00536342408","CALCIUM","","30","Select","Select",""],["","00378181510","LEVOTHYROXIN","150MCG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","50428016183","CVS","2000UNIT","30","Select","Select",""],["","65862020290","LOSARTAN","50MG","30","Select","Select",""],["","68180021509","LOSARTAN\/HCT","50-12.5","30","Select","Select",""],["","51991081403","AZELASTINE","0.10%","30","Select","Select",""],["","60505057501","OLOPATADINE","0.10%","5","Select","Select",""],["","31604001212","CALCIUM\/D","600-400","30","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","0.7","Select","Select",""],["","70461012103","FLUAD","2021-22","0.5","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","69618001001","ACETAMIN ","TAB 325MG","60","Select","Select",""],["","00536342408","CALCIUM ","","30","Select","Select",""],["","00378181510","LEVOTHYROXIN ","TAB 150MCG","30","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","50428016183","CVS ","CAP 2000UNIT","30","Select","Select",""],["","65862020290","LOSARTAN ","TAB 50MG","30","Select","Select",""],["","68180021509","LOSARTAN\/HCT ","TAB 50-12.5","30","Select","Select",""],["","51991081403","AZELASTINE ","SPR 0.001","30","Select","Select",""],["","60505057501","OLOPATADINE ","DRO 0.001","5","Select","Select",""],["","31604001212","CALCIUM\/D ","TAB 600-400","30","Select","Select",""],["","49281012065","FLUZONE ","INJ PF 20-21","0.7","Select","Select",""],["","70461012103","FLUAD ","INJ 2021-22","0.5","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","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","",""],["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":""}]}]}