{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRANDON   C POWELL","gend":0,"add":"5258 POLE GREEN RD","city":"MECHANICSVILLE","state":"VA","zip":"23116-5433","dob":"1998-05-03","age":"","mstatus":"","insh":10050139,"cliId":"","pno":8042017352,"cno":8042017352,"email":"","ename":"","eno":"","pphy":"VCU CENTER FOR ADVANCED HEALTH","ppno":8042543500,"pcpadd":"MCV Physicians, 2116 W Laburnum Ave Ste 100","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232274359,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"5258 POLE GREEN RD","madd2":"                                                            ","madd3":"","mcity":"MECHANICSVILLE","mstate":"VA","mzip":"23116-5433","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G89.29","M54.5","R09.81","Z79.899","R53.83","G43.809","R20.2","I61.8","G43.901","I61.1","R79.1","R77.9","I61.9","R51","D59.3","R47.01","R48.2","R53.1","M54.2","G08","I63.6","G93.6","I63.9","G81.91","G43.909","R00.0","F41.9","Z79.01","P78.3","R07.9","R00.2","I51.7","I15.1","R07.1","I30.9","R79.0","I21.09","I67.6","G40.909","I10","I50.21","I25.10","D49.89","J98.59","R91.8","J81.1","Z97.8","I21.4","J93.9","J98.4","D47.Z2","R94.31","N13.30","K66.1","D62","N17.9","R50.9","R11.2","R19.7","R21","M48.56XA","E86.9","N13.5","G93.89","R41.82","Z46.82","J96.01","I62.9","D68.69","G92","R57.8","R77.0","F06.31","R11.0","R52","R11.11","Z51.11","R11.10","G47.00","F41.8","Z51.5","G89.3","K20.8","E66.9","Z68.35","Z93.1","Z45.2","Z43.1","I25.2","G60.3","K21.0","N28.89","R16.1","G43.919","K59.00","Z01.818","Z11.59","Z09","Z87.19","K20.9","N13.2","Z01.812","G47.33","I15.9","I77.6","I42.9","K22.10","Z68.34","Z86.73","Z46.6","R59.0","R10.9","D63.0","E79.0","G62.9","D68.9","E83.42","T45.0X1A","G62.0","R79.82","R82.998","Z86.718","Z79.52","M79.2","K59.03","Z95.828","Z79.891","D68.61","D63.8","N13.1","R51.9","R16.0","N05.9","D69.6","R40.2362","R40.2142","W19.XXXA","F32.9","R56.9","G44.1","M54.9","R80.9","G44.40","M31.1","I69.351","H53.40","I69.390","I69.322","I69.398","H53.8","I69.320","I51.89","R79.89","I40.1","I51.4","D47.9","D84.9","J98.11","J98.6","M79.89","E87.70","I31.9","J69.0","N17.0","E43","K22.11","B33.22","N32.89","R18.8","Z96.0","Z46.59","I72.4","K92.2","E83.39","E87.5","R53.81","R59.9","R94.39","M32.9","Z68.36","R10.12","R74.8","D64.9","I34.1","D53.9","D69.59","D89.9","D59.9","M79.606","R71.8","J90","Z98.890","Z86.79","R22.2","I97.610","D68.32","I40.9","G43.A1","R14.3","S37.011A","R31.9","N13.9","A69.8","J34.89","Z48.816","Z87.820","I61.0","E87.1","E83.52","E86.0","I87.8","Z86.2","Z14.8","D89.89","B10.89","Z29.8","R31.0","I34.0","S37.031A","T45.1X5D","R76.8","R42","I67.9","Z23","I47.1","I25.3","N18.3","R93.1","R94.01","R90.82","J95.822","I36.1","N13.4","R93.89","R93.3","N28.81","Z51.81","K92.0","Z04.9","K94.23","T85.528A","Y83.1","Z88.6","K94.22","L02.211","G58.8","D72.829","R26.89","R55","Z90.2","K91.89","F33.1","J18.1","S30.1XXA","I95.9","I31.3","M48.50XA","R93.429","Z13.0","R22.43","I21.A1","N28.9","S30.1XXD","S37.019A","R23.2","K22.8","I49.1","I49.3","S37.009A"],"date":["2020-11-02","2019-09-04","2019-03-18","2021-03-19","2020-04-06","2019-06-24","2019-06-24","2019-06-25","2019-07-06","2019-12-14","2019-12-12","2019-07-06","2020-06-01","2019-09-04","2021-04-09","2019-07-10","2019-07-10","2020-08-30","2020-06-29","2020-08-30","2019-07-19","2019-07-19","2019-12-04","2019-07-24","2021-03-19","2021-03-02","2021-02-16","2021-02-16","2019-08-01","2020-08-30","2020-08-13","2019-12-30","2019-12-20","2019-11-03","2020-02-10","2019-10-29","2019-10-29","2021-03-30","2019-10-29","2020-11-02","2019-10-30","2019-10-30","2019-11-03","2020-08-26","2020-09-04","2020-09-04","2020-01-29","2019-12-18","2019-11-18","2020-03-19","2021-03-08","2019-12-15","2021-04-09","2020-07-02","2019-12-30","2021-03-03","2019-12-12","2020-11-04","2019-12-12","2019-12-12","2019-12-12","2019-12-20","2020-01-09","2019-12-13","2019-12-13","2019-12-15","2019-12-30","2019-12-20","2019-12-20","2019-12-20","2020-01-19","2019-12-23","2020-01-16","2021-02-16","2020-01-10","2020-01-19","2020-12-02","2020-01-10","2020-01-10","2020-01-10","2020-01-16","2021-02-16","2020-02-06","2020-08-21","2020-02-06","2020-08-06","2020-03-12","2020-08-21","2021-03-02","2020-08-06","2020-04-28","2020-08-26","2020-09-04","2020-08-06","2020-08-25","2020-07-20","2020-08-30","2020-07-22","2020-07-22","2020-07-22","2020-08-06","2020-08-04","2020-08-06","2020-08-06","2020-08-06","2021-03-02","2020-09-04","2020-08-06","2020-11-18","2021-03-03","2020-09-04","2020-09-04","2020-12-16","2020-09-04","2020-09-18","2020-09-04","2020-09-04","2020-10-14","2020-12-16","2020-10-14","2020-10-14","2021-01-18","2020-10-14","2020-11-18","2020-11-18","2020-11-18","2021-02-16","2021-03-03","2021-03-03","2021-03-03","2021-04-19","2019-06-25","2019-06-25","2020-09-01","2019-06-25","2019-06-25","2019-06-25","2020-06-19","2020-09-18","2019-11-03","2020-09-23","2020-08-31","2019-07-16","2019-12-04","2019-07-19","2019-07-19","2019-07-19","2019-07-19","2019-07-19","2019-07-19","2019-07-19","2019-10-28","2019-10-31","2019-10-30","2020-08-30","2019-10-30","2019-10-30","2020-09-04","2019-12-27","2019-12-10","2019-11-25","2020-03-11","2019-12-04","2019-12-04","2019-12-04","2019-12-04","2019-12-04","2019-12-09","2019-12-14","2020-09-16","2019-12-28","2020-02-10","2019-12-22","2019-12-30","2020-06-19","2020-02-14","2021-03-30","2020-02-10","2020-03-11","2020-08-21","2020-08-26","2020-08-26","2020-09-01","2020-08-31","2020-09-02","2020-09-03","2020-09-23","2020-09-09","2019-02-04","2019-08-28","2019-12-24","2019-11-18","2019-12-02","2019-12-02","2019-12-15","2019-12-07","2019-12-05","2020-07-02","2019-12-28","2020-09-04","2020-02-03","2020-02-03","2020-02-03","2020-07-20","2020-09-16","2019-02-12","2019-07-08","2019-07-09","2019-07-08","2019-07-08","2019-07-08","2019-08-05","2019-08-05","2019-11-01","2020-11-04","2019-12-09","2019-12-09","2019-12-30","2020-02-10","2020-11-04","2019-07-10","2020-08-30","2019-07-29","2019-09-18","2019-12-25","2020-03-19","2020-07-06","2021-03-02","2019-06-25","2019-07-05","2019-07-09","2019-10-30","2019-12-07","2019-12-08","2019-12-11","2019-12-14","2020-01-14","2019-12-22","2020-01-08","2020-06-19","2020-06-19","2020-06-19","2020-06-19","2020-09-04","2020-09-05","2019-07-19","2019-07-19","2019-07-19","2019-07-19","2019-11-01","2019-12-13","2019-12-18","2020-01-04","2020-01-04","2020-01-04","2020-01-04","2020-08-30","2020-09-28","2020-12-02","2019-07-09","2019-10-28","2019-10-28","2019-11-18","2019-12-09","2019-12-12","2019-12-22","2020-03-09","2020-03-09","2020-08-26"],"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":[["","16729017301","AMITRIPTYLIN ","TAB 50MG","30","Select","Select",""],["","00548560400","ENOXAPARIN ","INJ 80\/0.8ML","48","Select","Select",""],["","57237007530","ONDANSETRON ","TAB 4MG","20","Select","Select",""],["","64380072507","MYCOPHENOLAT ","TAB 500MG","120","Select","Select",""],["","00406855605","OXYCODONE ","SOL 5MG\/5ML","1,200.00","Select","Select",""],["","65162010350","GABAPENTIN ","CAP 400MG","90","Select","Select",""],["","00054001925","PREDNISONE ","TAB 50MG","4","Select","Select",""],["","00378668977","PANTOPRAZOLE ","TAB 40MG","60","Select","Select",""],["","00378018105","ALLOPURINOL ","TAB 300MG","30","Select","Select",""],["","00254200801","COLCHICINE ","TAB 0.6MG","60","Select","Select",""],["","31722077705","ACYCLOVIR ","TAB 400MG","60","Select","Select",""],["","68001011707","LEVETIRACETA ","TAB 500MG","120","Select","Select",""],["","59011041510","OXYCONTIN ","TAB 15MG CR","14","Select","Select",""],["","53746027205","SMZ\/TMP ","TAB 800-160","7","Select","Select",""],["","55111016330","OLANZAPINE ","TAB 2.5MG","30","Select","Select",""],["","68382009601","HYDROXYCHLOR ","TAB 200MG","30","Select","Select",""],["","00591024110","LORAZEPAM ","TAB 1MG","2","Select","Select",""],["","00406575501","METHADONE ","TAB 5MG","135","Select","Select",""],["","60258017101","MAG ","TAB 400MG","60","Select","Select",""],["","45802097426","CETIRIZINE ","SOL 1MG\/ML","300","Select","Select",""],["","00406324401","HYDROMORPHON ","TAB 4MG","135","Select","Select",""],["","00591264001","BUT\/APAP\/CAF ","CAP ","84","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","45802086802","POLYETH ","POW 3350 NF","238","Select","Select",""],["","00054317763","DEXAMETHASON ","SOL 0.5\/5ML","300","Select","Select",""],["","00093171401","WARFARIN ","TAB 2.5MG","50","Select","Select",""],["","68001025506","DULOXETINE ","CAP 20MG","15","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","105","Select","Select",""],["","00378021810","ATENOLOL ","TAB 25MG","15","Select","Select",""],["","68001013300","AMLOD\/BENAZP ","CAP 5-10MG","30","Select","Select",""],["","42858086806","DRONABINOL ","CAP 5MG","90","Select","Select",""],["","29300031781","RIZATRIPTAN ","TAB 10MG","12","Select","Select",""],["","15203002003","GAMMACORE ","MIS SAPPHIRE","1","Select","Select",""],["","00254101196","SUCRALFATE ","SUS 1GM\/10ML","1,260.00","Select","Select",""],["","46122001471","GNP ","POW ","510","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","69315011610","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","00093220401","METOCLOPRAM ","TAB 5MG","90","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","90","Select","Select",""],["","00378001805","METOPROL ","TAB 25MG","30","Select","Select",""],["","00591555401","PROPRANOLOL ","TAB 10MG","15","Select","Select",""],["","00071101668","LYRICA ","CAP 150MG","60","Select","Select",""],["","64980043150","OXYBUTYNIN ","TAB 5MG","30","Select","Select",""],["","00603015021","DOCQLACE ","CAP 100MG","60","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","20","Select","Select",""],["","42571016242","AMOX\/K ","875-125","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","",""],["No","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":""}]}]}