{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID JONES","gend":0,"add":"5200   MONTPELIER STREET                                    ","city":"HENRICO                       ","state":"VA","zip":"23231-3939","dob":"1958-03-11","age":"","mstatus":"","insh":10049606,"cliId":"","pno":8049390792,"cno":8049390792,"email":"","ename":"","eno":"","pphy":"VCU CENTER FOR ADVANCED HEALTH                              ","ppno":"","pcpadd":"MCV Physicians,2116 W Laburnum Ave Ste 100","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232274359,"pcpcounty":"","pcpid":"P0130488","pcpname":"VCU CENTER FOR ADVANCED HEALTH-SL","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"5200   MONTPELIER STREET                                    ","madd2":"                                                            ","madd3":"","mcity":"HENRICO                       ","mstate":"VA","mzip":"23231-3939","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.5","R68.89","Z21","F17.210","Z79.899","B20","I63.512","I25.10","Z79.82","F32.9","K21.9","E55.9","M79.673","Z86.73","I10","Z01.818","Z11.59","D12.3","Z12.11","D12.7","K64.8","K64.4","Z23","I65.29","I13.10","N18.9","Z76.0"],"date":["2020-11-24","2021-02-08","2019-08-27","2021-02-08","2021-01-19","2021-02-08","2020-04-21","2021-02-08","2020-06-23","2020-11-24","2021-02-08","2020-11-24","2020-11-24","2021-02-08","2020-07-08","2020-08-05","2020-08-05","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2021-04-23","2021-02-08","2021-02-08","2021-02-08","2021-02-08"],"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":[["","62175061743","PANTOPRAZOLE","40MG","30","Select","Select",""],["","61958250101","BIKTARVY","","30","Select","Select",""],["","43386006019","GAVILYTE-C","","4,000.00","Select","Select",""],["","50428166363","BISACODYL","5MG EC","4","Select","Select",""],["","70377002711","ATORVASTATIN","10MG","30","Select","Select",""],["","50428152314","CVS","325MG","30","Select","Select",""],["","68180071909","AMLODIPINE","2.5MG","30","Select","Select",""],["","00536123201","ASPIRIN","325MG EC","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","61958250101","BIKTARVY ","TAB ","30","Select","Select",""],["","00536123201","ASPIRIN ","TAB 325MG EC","30","Select","Select",""],["","68180071909","AMLODIPINE ","TAB 2.5MG","30","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","43386006019","GAVILYTE-C ","SOL ","4,000.00","Select","Select",""],["","50428166363","BISACODYL ","TAB 5MG EC","4","Select","Select",""],["","70377002711","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","50428152314","CVS ","TAB 325MG","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":""}]}]}