{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROOSEVELT   W ROBINSON","gend":0,"add":"1612  N 31ST STREET                                         ","city":"RICHMOND                      ","state":"VA","zip":"23223-5405","dob":"1957-05-13","age":"","mstatus":"","insh":10050532,"cliId":"","pno":8042749332,"cno":8042749332,"email":"","ename":"","eno":"","pphy":"VCU CENTER FOR ADVANCED HEALTH                              ","ppno":"","pcpadd":"MCV Physicians,Ste C","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232274359,"pcpcounty":"","pcpid":"P0130488","pcpname":"VCU CENTER FOR ADVANCED HEALTH-SL","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1612  N 31ST STREET                                         ","madd2":"                                                            ","madd3":"","mcity":"RICHMOND                      ","mstate":"VA","mzip":"23223-5405","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C22.0","R68.89","Z93.3","C44.520","K74.60","B19.20","B18.2","E11.65","E78.2","I10","R11.2","M06.849","K52.9","Z00.00","E11.9","E11.51","Z79.899","Z85.048","R52","K21.9","R11.0","Z51.81","M13.0","H25.13","N52.9","Z12.5","B36.0","C67.9","Z01.812","N32.9","R39.9","R31.0","R30.0","A63.0","D49.4","N30.40","C21.0","E78.5","F41.9","F32.9","M06.9","Z85.828","Z85.05","Z79.4","N32.89","Z92.3","R85.69","Z46.6","Z87.448","K91.2","H53.40","N32.0","G89.4","B37.2","E55.9","R10.9","E27.9","K94.01","Z85.038","F17.210","K76.9","C79.9","R63.4","Z92.21","Z90.49","R31.9","R33.9","Z23","N13.9","R33.8","Z96.0","C22.9","C79.71","I81","J98.09","J98.6","R18.8","K76.6","N17.9","N39.0","E87.5","N40.1","E44.0","K94.09","K72.90","B96.20","K74.69","N18.2","E87.6","R06.00","R00.0","R94.31","I49.9","K70.31","R16.0","K80.20","C78.7","N20.0","Z98.890","Z86.19","R79.89"],"date":["2020-04-22","2020-04-28","2020-05-01","2020-03-31","2020-04-24","2019-02-12","2020-04-24","2020-03-24","2020-02-04","2020-05-01","2019-02-27","2020-03-24","2020-03-24","2019-02-27","2020-05-01","2020-04-21","2020-03-18","2020-03-18","2020-05-01","2020-04-21","2019-05-22","2019-12-31","2019-12-31","2019-12-31","2019-06-18","2020-02-04","2019-08-26","2019-10-01","2019-09-20","2020-05-01","2019-09-20","2020-03-18","2020-03-18","2020-01-17","2019-10-01","2019-10-01","2020-05-01","2020-05-01","2019-10-01","2019-10-01","2019-10-01","2019-10-01","2019-10-01","2019-10-01","2020-03-20","2020-03-17","2019-10-01","2020-04-03","2019-10-11","2020-03-24","2019-12-31","2020-01-17","2020-03-24","2020-02-04","2020-02-04","2020-03-12","2020-03-12","2020-03-17","2020-03-12","2020-03-18","2020-03-12","2020-03-12","2020-04-15","2020-03-17","2020-05-01","2020-05-01","2020-04-03","2020-03-18","2020-03-18","2020-03-24","2020-03-30","2020-05-01","2020-04-21","2020-04-21","2020-04-21","2020-04-21","2020-04-24","2020-04-21","2020-04-24","2020-05-01","2020-04-21","2020-04-21","2020-04-21","2020-04-21","2020-04-21","2020-04-24","2020-04-22","2020-04-21","2020-04-21","2020-04-21","2020-04-24","2020-04-21","2020-04-22","2020-04-22","2020-04-22","2020-04-22","2020-04-24","2020-04-23","2020-04-23","2020-05-01","2020-04-24"],"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":[["","42858010301","OXYCOD\/APAP","7.5-325","120","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","60","Select","Select",""],["","57237001401","TAMSULOSIN","0.4MG","30","Select","Select",""],["","00172392770","DIAZEPAM","10MG","2","Select","Select",""],["","70377000215","SIMVASTATIN","10MG","30","Select","Select",""],["","00378041510","DIPHEN\/ATROP","2.5MG","90","Select","Select",""],["","66993005702","HYDROXYCHLOR","200MG","60","Select","Select",""],["","65862039110","ONDANSETRON","8MG ODT","6","Select","Select",""],["","00603497532","OXYBUTYNIN","5MG","30","Select","Select",""],["","00378021610","FUROSEMIDE","40MG","30","Select","Select",""],["","53746051501","SPIRONOLACT","100MG","30","Select","Select",""],["","68462018135","CLOTRIMAZOLE","1%","30","Select","Select",""],["","65862055990","PANTOPRAZOLE","20MG","14","Select","Select",""],["","57896045401","GERI-KOT","8.6MG","20","Select","Select",""],["","45802086802","POLYETH","3350 NF","238","Select","Select",""],["","00378025710","HALOPERIDOL","1MG","30","Select","Select",""],["","00093220401","METOCLOPRAM","5MG","28","Select","Select",""],["","68180098003","LISINOPRIL","10MG","30","Select","Select",""],["","00093031101","LOPERAMIDE","2MG","84","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","90","Select","Select",""],["","17478071130","LIDOCAINE","2% JELLY","30","Select","Select",""],["","10702005601","OXYCODONE","10MG","60","Select","Select",""],["","42858010301","OXYCOD\/APAP ","TAB 7.5-325","120","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","00172392770","DIAZEPAM ","TAB 10MG","2","Select","Select",""],["","70377000215","SIMVASTATIN ","TAB 10MG","30","Select","Select",""],["","00378041510","DIPHEN\/ATROP ","TAB 2.5MG","90","Select","Select",""],["","66993005702","HYDROXYCHLOR ","TAB 200MG","60","Select","Select",""],["","65862039110","ONDANSETRON ","TAB 8MG ODT","6","Select","Select",""],["","00603497532","OXYBUTYNIN ","TAB 5MG","30","Select","Select",""],["","00378021610","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","53746051501","SPIRONOLACT ","TAB 100MG","30","Select","Select",""],["","68462018135","CLOTRIMAZOLE ","CRE 0.01","30","Select","Select",""],["","65862055990","PANTOPRAZOLE ","TAB 20MG","14","Select","Select",""],["","57896045401","GERI-KOT ","TAB 8.6MG","20","Select","Select",""],["","45802086802","POLYETH ","POW 3350 NF","238","Select","Select",""],["","00378025710","HALOPERIDOL ","TAB 1MG","30","Select","Select",""],["","00093220401","METOCLOPRAM ","TAB 5MG","28","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","00093031101","LOPERAMIDE ","CAP 2MG","84","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","17478071130","LIDOCAINE ","GEL 2% JELLY","30","Select","Select",""],["","10702005601","OXYCODONE ","TAB 10MG","60","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":""}]}]}