{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANNETTE JOHNSON","gend":0,"add":"1611   HOPERDAPTA  STREET                                   ","city":"GLEN ALLEN                    ","state":"VA","zip":"23060-9998","dob":"1957-10-09","age":"","mstatus":"","insh":10049540,"cliId":"","pno":8043097557,"cno":8043097557,"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":"APT A                                                       ","add3":"","madd1":"1611   HOPERDAPTA  STREET                                   ","madd2":"APT A                                                       ","madd3":"","mcity":"GLEN ALLEN                    ","mstate":"VA","mzip":"23060-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F25.0","I10","F39","Z11.3","Z12.4","Z12.11","Z12.31","E55.9","F34.1","E78.2","M25.562","M54.5","E87.6","G89.29","D33.1","M25.561","F51.01","R42","Z87.891","N30.91","S39.012A","S86.912A","W19.XXXA","W01.0XXA","Y92.512","Z79.82","Z79.899","F31.5","M54.32","M47.817","R20.1","M54.42","M54.41","R29.898","R26.9","M48.061","M51.36","M51.26","R93.7","N30.90","J30.89","M54.16","R82.998","M79.605","M79.606","M25.552","Z20.822","R05"],"date":["2020-09-21","2019-04-01","2021-07-19","2019-05-21","2021-05-12","2019-05-21","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2020-03-20","2021-07-19","2021-05-12","2020-03-20","2019-06-10","2020-03-20","2021-05-12","2020-01-25","2020-03-20","2020-03-14","2020-03-20","2020-03-20","2020-03-20","2020-03-20","2020-03-20","2020-03-20","2020-03-20","2020-03-23","2020-08-12","2020-08-12","2020-08-12","2020-04-24","2020-04-07","2020-04-24","2020-04-24","2020-05-14","2020-05-14","2020-05-14","2020-08-25","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-07-19","2021-07-19","2021-07-20","2021-09-02","2021-09-02"],"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":[["","45802065087","LORATADINE","10MG","30","Select","Select",""],["","55111012105","ATORVASTATIN","10MG","30","Select","Select",""],["","00378623101","CITALOPRAM","10MG","30","Select","Select",""],["","33342007810","VALSART\/HCTZ","320-25MG","30","Select","Select",""],["","50111043302","TRAZODONE","50MG","30","Select","Select",""],["","00904582460","VITAMIN","1000UNIT","30","Select","Select",""],["","68382032001","POT CHLORIDE","10MEQ ER","30","Select","Select",""],["","68462019005","NAPROXEN","500MG","60","Select","Select",""],["","00115164501","NITROFUR","100MG","14","Select","Select",""],["","00527133001","BACLOFEN","10MG","90","Select","Select",""],["","65162010150","GABAPENTIN","100MG","90","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","31604002683","D3","1000UNIT","90","Select","Select",""],["","00185012201","NITROFURANTN","100MG","14","Select","Select",""],["","00766165675","OS-CAL","500-200","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","00093031401","KETOROLAC","10MG","10","Select","Select",""],["","43547034050","RISPERIDONE","0.5MG","30","Select","Select",""],["","00591367101","NABUMETONE","750MG","60","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","30","Select","Select",""],["","55111012105","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","00378623101","CITALOPRAM ","TAB 10MG","30","Select","Select",""],["","33342007810","VALSART\/HCTZ ","TAB 320-25MG","30","Select","Select",""],["","50111043302","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","00904582460","VITAMIN ","TAB 1000UNIT","30","Select","Select",""],["","68382032001","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","60","Select","Select",""],["","00115164501","NITROFUR ","CAP 100MG","14","Select","Select",""],["","00527133001","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","65162010150","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","31604002683","D3 ","TAB 1000UNIT","90","Select","Select",""],["","00185012201","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","00766165675","OS-CAL ","TAB 500-200","30","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","10","Select","Select",""],["","43547034050","RISPERIDONE ","TAB 0.5MG","30","Select","Select",""],["","00591367101","NABUMETONE ","TAB 750MG","60","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":""}]}]}