{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DIRON   R PEETE","gend":0,"add":"302   PILOT KNOB LOOP                                       ","city":"STAFFORD                      ","state":"VA","zip":"22554-8477","dob":"1972-01-08","age":"","mstatus":"","insh":10050375,"cliId":"","pno":5404557098,"cno":5404557098,"email":"","ename":"","eno":"","pphy":"ANBESSIE, TEDLA B                                           ","ppno":"","pcpadd":"2146 Jefferson Davis Hwy","pcpcity":"Stafford                      ","pcpstate":"VA","pcpzip":225547223,"pcpcounty":"","pcpid":"P9443127","pcpname":"AQUIA FAMILY MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"APT 203                                                     ","add3":"","madd1":"302   PILOT KNOB LOOP                                       ","madd2":"APT 203                                                     ","madd3":"","mcity":"STAFFORD                      ","mstate":"VA","mzip":"22554-8477","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","I10","E11.65","E78.2","Z00.00","J32.9","J31.0","R09.81","I26.99","J44.1","N28.9","R07.89","R06.02","R77.8","R94.5","F17.200","I25.810","I27.20","I50.20","I26.02","Y84.8","Z68.44","L76.32","I50.32","J44.9","I11.0","R09.02","E66.01","I50.9","Z79.4","I26.09","I26.92","R07.9","J45.909","E11.9","L53.9","R74.8","K76.0","M79.89","M79.604","M79.605","R06.00","Z45.2","D68.69","G47.30","E66.9","M54.2","M54.9","K76.89","M54.5","R52","E29.1","M54.12","G89.4","M51.36","M47.812","M51.16","M51.26","R94.31","M54.16","M54.31","D64.9","D68.59","R53.83","Z87.09","M48.00","R10.13","R12","K59.00","Z12.11","R30.0","D75.1","C85.90","D72.819","R31.9","Z01.810","Z79.01","D50.9","E53.8","D51.9","D52.9","G62.9","E11.40","F32.9","M79.2","E78.5","I82.409","M54.09","M17.9"],"date":["2021-08-30","2021-11-08","2020-07-03","2020-02-28","2019-04-19","2019-07-11","2019-07-11","2019-07-11","2021-10-19","2020-02-11","2020-02-11","2020-02-11","2021-04-19","2020-02-11","2020-02-11","2020-02-11","2020-02-11","2021-06-08","2020-02-11","2020-02-14","2020-02-11","2020-02-11","2020-02-11","2020-02-11","2021-10-19","2020-02-11","2020-02-11","2020-12-09","2020-02-11","2021-11-08","2020-02-13","2020-02-11","2020-02-11","2020-02-11","2021-11-08","2020-02-11","2021-04-19","2020-06-02","2020-02-12","2020-02-12","2020-02-12","2020-02-11","2020-02-12","2020-02-20","2021-10-19","2021-07-02","2020-02-25","2021-10-06","2020-02-28","2020-09-22","2020-03-10","2020-12-03","2021-03-10","2021-11-05","2021-02-12","2020-05-14","2020-05-14","2020-05-14","2020-05-21","2021-11-05","2020-10-21","2020-06-02","2020-10-07","2020-06-23","2020-10-23","2020-11-19","2020-11-19","2020-11-19","2020-11-19","2020-11-19","2020-11-19","2020-12-16","2020-12-16","2020-11-20","2020-12-03","2020-12-10","2021-07-02","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-05-06","2021-05-06","2021-10-14","2021-10-06","2021-10-14","2021-10-19","2021-11-05","2021-11-05"],"priorHcc":["",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","",null,"","","","","","","","","","","","","","","","","","",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":[["","00169406012","VICTOZA","18MG\/3ML","6","Select","Select",""],["","57664047758","METOPROL","50MG","60","Select","Select",""],["","70010006310","METFORMIN","500MG","180","Select","Select",""],["","08290320119","BD PEN NEEDL","31GX5MM","60","Select","Select",""],["","00169369619","NOVOLOG","FLEXPEN","45","Select","Select",""],["","51991074790","DULOXETINE","30MG","30","Select","Select",""],["","10702001801","OXYCODONE","5MG","56","Select","Select",""],["","67877022205","GABAPENTIN","100MG","60","Select","Select",""],["","00193725201","CONTOUR","NEXT EZ","1","Select","Select",""],["","31722055190","LEVOCETIRIZI","5MG","90","Select","Select",""],["","00193658621","MICROLET","LANCETS","200","Select","Select",""],["","60505079504","ENOXAPARIN","100MG\/ML","4","Select","Select",""],["","00832121610","JANTOVEN","5MG","75","Select","Select",""],["","00591321730","TESTOSTERONE","1%(50MG)","150","Select","Select",""],["","00002882427","HUMULIN","U-500","42","Select","Select",""],["","00143965901","TESTOST","200MG\/ML","1","Select","Select",""],["","69097045905","FENOFIBRATE","48MG","30","Select","Select",""],["","60505016909","PRAVASTATIN","20MG","30","Select","Select",""],["","80681013700","CALCIUM","500-10","60","Select","Select",""],["","68180072103","AMLODIPINE","10MG","30","Select","Select",""],["","68180051801","LISINOP\/HCTZ","10-12.5","90","Select","Select",""],["","11534016503","FOLIC","1MG","90","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","69315011710","FUROSEMIDE","40MG","90","Select","Select",""],["","10572010001","PEG-3350","ELECTROL","4,000.00","Select","Select",""],["","59762040101","SUCRALFATE","1GM","120","Select","Select",""],["","00169406012","VICTOZA ","INJ 18MG\/3ML","6","Select","Select",""],["","57664047758","METOPROL ","TAB 50MG","60","Select","Select",""],["","70010006310","METFORMIN ","TAB 500MG","180","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","56","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","60","Select","Select",""],["","00169369619","NOVOLOG ","INJ FLEXPEN","45","Select","Select",""],["","51991074790","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","67877022205","GABAPENTIN ","CAP 100MG","30","Select","Select",""],["","60505016909","PRAVASTATIN ","TAB 20MG","30","Select","Select",""],["","69097045905","FENOFIBRATE ","TAB 48MG","30","Select","Select",""],["","00193725201","CONTOUR ","KIT NEXT EZ","1","Select","Select",""],["","31722055190","LEVOCETIRIZI ","TAB 5MG","90","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","200","Select","Select",""],["","60505079504","ENOXAPARIN ","INJ 100MG\/ML","4","Select","Select",""],["","00832121610","JANTOVEN ","TAB 5MG","75","Select","Select",""],["","68180052001","LISINOP\/HCTZ ","TAB 20-25MG","30","Select","Select",""],["","00591321730","TESTOSTERONE ","GEL 1%(50MG)","150","Select","Select",""],["","00002882427","HUMULIN ","INJ U-500","42","Select","Select",""],["","00143965901","TESTOST ","INJ 200MG\/ML","1","Select","Select",""],["","80681013700","CALCIUM ","CHW 500-10","60","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","11534016503","FOLIC ","TAB 1MG","90","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","69315011710","FUROSEMIDE ","TAB 40MG","90","Select","Select",""],["","10572010001","PEG-3350 ","SOL ELECTROL","4,000.00","Select","Select",""],["","59762040101","SUCRALFATE ","TAB 1GM","120","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","",""],["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":""}]}]}