{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANN   N LOWE","gend":1,"add":"7442 GRAPELEAF DR","city":"N CHESTERFIELD","state":"VA","zip":"23234-2867","dob":"1970-02-28","age":"","mstatus":"","insh":10049801,"cliId":"","pno":4347280226,"cno":8048522190,"email":"","ename":"","eno":"","pphy":"SALMAN AKBAR MD","ppno":8043305452,"pcpadd":"949 PINEY FOREST RD, ","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":245411591,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":8048522190,"add2":"                                                            ","add3":"","madd1":"7442 GRAPELEAF DR","madd2":"                                                            ","madd3":"","mcity":"N CHESTERFIELD","mstate":"VA","mzip":"23234-2867","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I83.813","M79.89","M47.816","M47.817","M54.16","M51.36","R68.89","M48.061","R10.9","E11.9","I10","Z87.891","F31.63","F43.10","F41.1","F31.60","F60.9","Z51.81","D64.9","N18.9","M54.5","Z86.19","K74.0","K76.0","E66.01","E88.81","Z68.43","E78.5","G51.0","I87.323","I87.2","R60.0","G89.4","E55.9","N18.30","Z02.89","B18.2","G89.29","R90.82","R20.0","I63.9","R05","J45.909","K21.9","I83.893","I89.0","E11.319","E66.9","B19.20","Z79.4","R29.810","E27.9","Z00.00","R73.09","E78.00","R51","R60.9","N17.9","R94.31","Z12.31","Z13.228","D72.18","F32.3","J44.1","F31.0","E10.8","R78.89","Z83.3","Z79.899","D72.829","D47.3","F31.9","R29.704","H53.149","H53.8","R07.9","F41.8","I50.20","J45.998"],"date":["2019-03-07","2019-03-07","2021-03-25","2021-05-20","2021-03-25","2021-03-25","2020-10-14","2019-10-19","2019-11-01","2021-02-12","2021-02-12","2019-11-01","2021-04-28","2021-04-28","2021-04-28","2021-03-05","2021-03-05","2021-03-05","2020-10-29","2020-11-03","2019-01-29","2019-02-08","2019-02-08","2019-04-26","2019-05-28","2019-02-08","2019-05-28","2021-02-12","2019-05-29","2019-06-18","2019-06-18","2019-10-01","2021-03-25","2020-10-29","2020-10-29","2021-04-30","2019-02-08","2019-10-01","2019-05-28","2019-05-28","2019-05-29","2019-06-14","2020-05-05","2020-07-28","2019-06-27","2019-06-27","2019-04-26","2019-04-26","2019-04-26","2019-04-26","2019-05-28","2019-11-21","2020-01-09","2020-10-14","2020-10-14","2019-05-28","2020-11-25","2020-11-19","2019-05-28","2019-10-28","2020-11-19","2020-11-19","2019-01-31","2019-01-31","2019-03-11","2019-03-11","2019-03-11","2019-04-26","2019-04-26","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-07-19","2020-01-09"],"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":[["","00085113204","PROVENTIL ","AER HFA","6.7","Select","Select",""],["","42858010401","OXYCOD\/APAP ","TAB 10-325MG","90","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","48","Select","Select",""],["","68382076010","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","00245531911","KLOR-CON ","TAB 20MEQ ER","30","Select","Select",""],["","60505014201","GLIPIZIDE ","TAB 10MG","60","Select","Select",""],["","00378021610","FUROSEMIDE ","TAB 40MG","60","Select","Select",""],["","00093816401","QUETIAPINE ","TAB 300MG","30","Select","Select",""],["","70377002711","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","60505294509","EZETIMIBE ","TAB 10MG","30","Select","Select",""],["","68382003616","VENLAFAXINE ","CAP 150MG ER","30","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","00006027731","JANUVIA ","TAB 100MG","30","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","00054452725","LITHIUM ","TAB 300MG","30","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","60","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","00597015230","JARDIANCE ","TAB 10MG","30","Select","Select",""],["","68180051703","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","67877022310","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","65162068090","PROMETHAZINE ","SOL DM","180","Select","Select",""],["","49884012201","LABETALOL ","TAB 100MG","60","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","00093720110","PRAVASTATIN ","TAB 20MG","30","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","180","Select","Select",""],["","70461031903","FLUCLVX ","INJ 2019-20","0.5","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","2","Select","Select",""],["","65862050220","AMOX\/K ","TAB 500-125","20","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","3","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0.3","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}