{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NESHELL MAXEY","gend":1,"add":"5031 GRAND OAKS FOREST CIRCLE","city":"CHESTER","state":"VA","zip":"23831-4268","dob":"1969-08-12","age":"","mstatus":"","insh":10049671,"cliId":"","pno":8046619304,"cno":8043127089,"email":"","ename":"","eno":"","pphy":"BECKWITH, DOUGLAS E","ppno":8047962373,"pcpadd":"12901 Briggs Rd, ","pcpcity":"Chester","pcpstate":"VA","pcpzip":238315335,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":8045858694,"add2":"APT 207","add3":"","madd1":"5031 GRAND OAKS FOREST CIRCLE","madd2":"APT 207","madd3":"","mcity":"CHESTER","mstate":"VA","mzip":"23831-4268","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.22","Z95.811","E66.9","I27.20","I10","Z68.41","Z79.01","I51.7","R53.1","I50.23","I47.2","Z95.810","I11.0","Z68.39","Z79.899","R82.998","Z11.3","Z11.4","Z78.0","N39.0","I50.9","R68.89","I50.84","Z87.891","Z68.36","R00.2","I50.1","R05","B34.9","I42.9","T82.198A","R42","R06.02","B96.1","I95.9","D64.9","I27.22","E87.70","I50.20","D50.9","M54.2","E87.6","R03.0","D62","I47.1","K59.09","I48.19","L76.32","Y83.8","J98.4","D72.829","I48.0","K59.00","J81.1","R91.8","T82.9XXA","I50.42","I13.0","I42.8","Z16.24","Z16.12","E78.5","E66.01","Z68.33","I35.1","E04.1","B96.20","Z45.09","Z87.440","Z76.82","Z79.2","I50.814","Z98.890","Z95.0","N18.30","K04.7","H61.23","I50.810","I34.0","E87.79","N17.9","R74.8","I36.1","Z87.19","R94.31","R57.0","K72.00","J69.0","E87.1","I31.4","D68.9","E87.2","I48.92","I08.0","I45.9","T82.897A","J90","R57.8","R40.4","R51","O90.3","I38","J98.6","Z46.82","J98.11","M79.622","M79.621","R09.89","T82.598A","R51.9","R35.0","R39.15","Z86.79","I48.91","I27.29","Z09","R07.9","T88.8XXS","R50.9","Z45.2","Z86.711","I49.3","R00.0","I42.0","Z86.74","R06.00","Z20.828","F34.1","I45.81","M79.609","R07.89","N64.4","M54.9","I08.3","I77.810","I87.8","E04.2","I08.8","B97.29","I31.3","E86.9","Z45.02","E66.1","L27.0","N30.00","I44.0","R06.89","J18.1","J98.19","T85.848A","I49.8","I50.31","Z12.31","R93.1","R74.0","Z01.818","R79.1","I46.9","I77.89","T85.838A","J93.9","I20.0","G89.18","K59.03","S20.02XA","R04.0","Z79.82","E86.1","N18.2","Z68.42","R93.2","N18.9","Z88.1","I49.1","R11.10","I28.1","R73.9","I31.2","S20.211A","J98.09","R06.09","R53.81"],"date":["2021-05-05","2021-05-13","2020-05-19","2021-02-25","2020-11-27","2019-02-28","2021-05-13","2021-02-25","2020-09-21","2020-12-20","2020-12-19","2020-10-02","2021-05-05","2019-05-30","2020-12-15","2019-09-13","2019-09-13","2019-09-13","2019-09-13","2020-12-10","2021-05-05","2020-12-01","2021-05-05","2020-03-11","2020-05-19","2020-01-18","2021-03-09","2020-09-19","2020-03-01","2021-01-08","2020-08-08","2021-02-25","2020-12-20","2020-09-21","2020-08-29","2020-09-05","2020-08-29","2020-09-12","2021-04-16","2020-12-19","2020-08-29","2020-10-02","2020-09-06","2020-09-20","2020-09-06","2020-09-12","2020-09-09","2020-09-07","2020-09-07","2020-09-13","2020-09-11","2020-09-20","2020-09-14","2020-12-17","2020-10-02","2020-10-03","2020-10-03","2020-12-15","2020-12-13","2020-10-04","2020-10-03","2020-12-13","2020-12-13","2020-12-13","2020-10-04","2020-10-04","2020-10-04","2021-05-05","2021-02-02","2021-01-06","2021-02-02","2021-05-13","2020-11-06","2020-12-13","2020-12-15","2020-12-22","2019-01-11","2020-12-19","2019-09-18","2019-03-03","2020-08-31","2019-03-03","2019-09-18","2019-05-02","2020-09-08","2020-09-29","2020-08-23","2020-08-23","2020-09-11","2020-08-30","2020-08-23","2020-08-23","2020-08-23","2020-12-13","2021-02-25","2020-08-30","2020-10-02","2020-09-03","2019-02-16","2020-09-19","2020-09-21","2019-02-28","2020-09-15","2020-09-06","2020-12-17","2020-09-08","2020-09-08","2020-09-20","2020-10-02","2020-10-02","2020-10-02","2020-10-02","2021-01-06","2020-12-19","2020-12-19","2021-02-02","2021-02-25","2020-08-30","2020-08-31","2020-09-02","2020-09-05","2020-10-02","2020-10-02","2020-12-13","2020-12-13","2021-02-25","2021-04-19","2021-05-24","2019-02-23","2020-09-08","2020-09-09","2020-09-13","2020-09-09","2020-10-03","2020-10-03","2020-10-12","2020-10-04","2020-10-12","2020-11-27","2021-02-25","2019-02-23","2021-04-16","2020-01-07","2020-01-07","2020-02-05","2020-03-01","2020-08-22","2020-09-03","2020-09-09","2020-09-05","2020-09-08","2020-12-13","2019-01-21","2019-03-04","2019-08-26","2019-08-26","2020-08-28","2020-08-30","2020-08-31","2020-09-07","2020-09-07","2020-01-17","2020-09-10","2020-09-10","2020-09-17","2020-09-18","2020-12-15","2019-02-17","2019-02-17","2019-02-17","2019-08-26","2019-09-06","2019-09-06","2020-08-22","2020-08-30","2020-08-30","2020-09-03","2020-09-03","2020-09-03","2020-09-08","2020-12-13","2020-12-13"],"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":[["","81131031251","IRON ","TAB 325MG","90","Select","Select",""],["","31722070090","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","59746021601","SPIRONOLACT ","TAB 25MG","60","Select","Select",""],["","00904645780","DOK ","CAP 100MG","30","Select","Select",""],["","65162035109","SILDENAFIL ","TAB 20MG","90","Select","Select",""],["","68645049254","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","68382009205","CARVEDILOL ","TAB 3.125MG","60","Select","Select",""],["","50111091701","TORSEMIDE ","TAB 20MG","60","Select","Select",""],["","57237012401","WARFARIN ","TAB 5MG","30","Select","Select",""],["","50111032801","HYDRALAZINE ","TAB 50MG","180","Select","Select",""],["","57237002901","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","49035007841","EQ ","CAP SOFTENER","30","Select","Select",""],["","68645055254","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","90","Select","Select",""],["","16714043901","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","57896090110","ASPIRIN ","TAB 325MG","90","Select","Select",""],["","68382022714","AMIODARONE ","TAB 200MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","31722093612","OMEGA-3-ACID ","CAP 1GM","120","Select","Select",""],["","00173088408","LOVAZA ","CAP 1GM","120","Select","Select",""],["","00245014760","PACERONE ","TAB 200MG","90","Select","Select",""],["","00078065967","ENTRESTO ","TAB 24-26MG","180","Select","Select",""],["","42037010479","DEBROX ","SOL 6.5% OT","15","Select","Select",""],["","12843003520","STOOL ","CAP 100MG","30","Select","Select",""],["","00904759160","FERROUS ","TAB 325MG","90","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","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":""}]}]}