{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERRIDA RIVERA","gend":1,"add":"1028 W WYTHE STREET                                         ","city":"PETERSBURG                    ","state":"VA","zip":"23803-4012","dob":"1967-10-19","age":"","mstatus":"","insh":10050082,"cliId":"","pno":7579031579,"cno":7579031579,"email":"","ename":"","eno":"","pphy":"DUHART, HAROLD BOBBY                                        ","ppno":"","pcpadd":"541 S Sycamore St","pcpcity":"Petersburg                    ","pcpstate":"VA","pcpzip":238035039,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1028 W WYTHE STREET                                         ","madd2":"                                                            ","madd3":"","mcity":"PETERSBURG                    ","mstate":"VA","mzip":"23803-4012","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","1",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K21.9","I10","H60.333","M79.89","M25.571","M25.572","G89.29","J02.9","H66.90","M54.5","E78.2","E55.9","Z13.1","M25.562","M79.641","M79.642","J30.2","G43.909","J45.901","M51.27","Z00.00","E11.9","E61.1","Z71.3","R53.83","J45.40","Z91.09","Z71.89","M54.9","M48.00","M77.51","M77.52","M77.32","R60.0","M51.9","M79.606","M79.605","E66.01","F41.9","F40.10","F32.9","Z68.43","R26.89","N39.42","R39.81","H60.331","B37.2","F39","E78.5","R63.4","Z13.21","M79.672","M17.12","E66.9","M13.80"],"date":["2020-12-07","2021-05-14","2019-02-22","2019-02-22","2019-11-15","2020-03-11","2019-09-07","2019-02-22","2019-03-12","2021-05-14","2021-01-11","2021-05-14","2021-01-11","2021-05-25","2019-06-12","2019-06-12","2019-03-19","2020-03-11","2019-05-24","2019-06-13","2019-10-09","2019-04-17","2021-01-11","2021-01-11","2019-06-19","2021-01-11","2021-01-11","2021-01-11","2020-03-11","2019-06-25","2019-06-27","2019-06-27","2019-06-27","2019-11-15","2019-07-17","2019-09-07","2021-05-28","2021-01-11","2019-10-09","2019-10-09","2019-10-09","2019-10-09","2019-11-15","2021-11-02","2021-11-02","2020-03-11","2020-03-11","2020-03-11","2020-12-07","2021-01-07","2021-01-11","2021-01-11","2021-05-25","2021-11-02","2021-11-02"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,"","","","","","","","",null,null]}},{"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":[["","68180096301","ALBUTEROL","HFA","8.5","Select","Select",""],["","45802016000","DICLOFENAC","1%","100","Select","Select",""],["","87701040741","VITAMIN","500MG","15","Select","Select",""],["","16729011917","MONTELUKAST","10MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","30","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10.2","Select","Select",""],["","00245010811","FERROUS","325MG EC","15","Select","Select",""],["","50228018005","GABAPENTIN","300MG","30","Select","Select",""],["","00093720110","PRAVASTATIN","20MG","30","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","67877019810","AMLODIPINE","5MG","30","Select","Select",""],["","16729018317","HYDROCHLOROT","25MG","30","Select","Select",""],["","69315030630","NYSTATIN","100000","30","Select","Select",""],["","57896040110","DOCUSATE","100MG","30","Select","Select",""],["","55111029109","SUMATRIPTAN","25MG","18","Select","Select",""],["","00832046515","NYAMYC","100000","15","Select","Select",""],["","64380080707","IBUPROFEN","800MG","90","Select","Select",""],["","11822880140","RA","B-50","30","Select","Select",""],["","50383090110","HC\/ACET","OTIC","10","Select","Select",""],["","00065853302","CIPRODEX","0.3-0.1%","7.5","Select","Select",""],["","51991074890","DULOXETINE","60MG","30","Select","Select",""],["","57896040810","STOOL","100MG","30","Select","Select",""],["","00093506001","HYDROXYZ","10MG","60","Select","Select",""],["","60505025203","TIZANIDINE","4MG","60","Select","Select",""],["","55111012205","ATORVASTATIN","20MG","30","Select","Select",""],["","00904645780","DOK","100MG","180","Select","Select",""],["","00904759080","FEROSUL","325MG","15","Select","Select",""],["","68180096301","ALBUTEROL ","AER HFA","8.5","Select","Select",""],["","45802016000","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","87701040741","VITAMIN ","TAB 500MG","15","Select","Select",""],["","16729011917","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","00245010811","FERROUS ","TAB 325MG EC","15","Select","Select",""],["","50228018005","GABAPENTIN ","CAP 300MG","30","Select","Select",""],["","00093720110","PRAVASTATIN ","TAB 20MG","30","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","67877019810","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","16729018317","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","69315030630","NYSTATIN ","POW 100000","30","Select","Select",""],["","57896040110","DOCUSATE ","CAP 100MG","30","Select","Select",""],["","55111029109","SUMATRIPTAN ","TAB 25MG","18","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","2","Select","Select",""],["","00832046515","NYAMYC ","POW 100000","15","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","11822880140","RA ","TAB B-50","30","Select","Select",""],["","50383090110","HC\/ACET ","SOL OTIC","10","Select","Select",""],["","00065853302","CIPRODEX ","SUS 0.3-0.1%","7.5","Select","Select",""],["","51991074890","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","57896040810","STOOL ","CAP 100MG","30","Select","Select",""],["","00093506001","HYDROXYZ ","TAB 10MG","60","Select","Select",""],["","60505025203","TIZANIDINE ","TAB 4MG","60","Select","Select",""],["","55111012205","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","00904645780","DOK ","CAP 100MG","180","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":""}]}]}