{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"OSBY   H TERRY","gend":0,"add":"7014 NARRAGANSETT COURTS                                    ","city":"MECHANICSVILLE                ","state":"VA","zip":"23111-4638","dob":"1990-06-03","age":"","mstatus":"","insh":10050697,"cliId":"","pno":8043802840,"cno":8043802840,"email":"","ename":"","eno":"","pphy":"VCU CENTER FOR ADVANCED HEALTH                              ","ppno":"","pcpadd":"MCV Physicians","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":"7014 NARRAGANSETT COURTS                                    ","madd2":"                                                            ","madd3":"","mcity":"MECHANICSVILLE                ","mstate":"VA","mzip":"23111-4638","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N28.9","Q85.1","D49.6","I10","R56.9","G40.909","N20.0","I51.9","E78.5","E78.00","Z79.899","D21.9","I51.7","D15.1","R00.2","Z71.3","G24.1","Z71.82","D43.2","R93.1","M25.561","G93.89","R51","R52","W19.XXXA","C71.9","I35.1","I36.1","Z86.018","Z23","R07.89","I45.9","I99.8","Z20.828","S46.912A","M54.6","M25.512","V49.40XA","Y92.411","S46.911A","E55.9","G93.0","Z98.890"],"date":["2019-01-18","2021-11-27","2020-10-12","2021-08-25","2020-11-30","2021-10-11","2021-10-11","2019-01-31","2021-08-25","2020-09-09","2021-06-23","2020-11-09","2019-04-22","2021-01-11","2019-12-16","2019-11-22","2019-11-13","2019-11-22","2021-11-27","2019-12-16","2020-03-02","2021-10-11","2020-06-07","2020-06-07","2020-06-07","2021-10-11","2020-09-28","2020-09-28","2020-09-28","2021-10-11","2020-11-09","2020-11-09","2021-01-11","2021-03-08","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2021-10-11","2021-11-27","2021-11-27"],"priorHcc":["",null,"","","",null,null,"","","","","","","","","","","",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":[["","60505280707","CARBAMAZEPIN","300MG ER","360","Select","Select",""],["","69097012303","TOPIRAMATE","50MG","120","Select","Select",""],["","43547040011","CYCLOBENZAPR","10MG","15","Select","Select",""],["","65162019050","NAPROXEN","500MG","30","Select","Select",""],["","00078056751","AFINITOR","10MG","28","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","7","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","60505280707","CARBAMAZEPIN ","CAP 300MG ER","360","Select","Select",""],["","69097012303","TOPIRAMATE ","TAB 50MG","120","Select","Select",""],["","43547040011","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","00078056751","AFINITOR ","TAB 10MG","28","Select","Select",""],["","16729018201","HYDROCHLOROT ","TAB 12.5MG","7","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","90","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":""}]}]}