{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" LOUIS TAYLOR","gend":0,"add":"426 E 16TH ST","city":"N CHESTERFLD","state":"VA","zip":"23224-9998","dob":"1954-07-20","age":"","mstatus":"","insh":10050914,"cliId":"","pno":"8042373819, 8042373819","cno":"","email":"","ename":"","eno":"","pphy":"UNKNOWN PROVIDER QNXT PCP","ppno":"               ","pcpadd":"UNKNOWN STREET, ","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":232190000,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"426 E 16TH ST","madd2":"                                                            ","madd3":"","mcity":"N CHESTERFLD","mstate":"VA","mzip":"23224-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","F33.1","F33.2","S22.42XA","S60.511A","W11.XXXA","R00.2","I48.0","R94.31","I10","E11.65","K21.9","E11.21","Z79.4","F13.10","Z87.891","R30.0","R39.12","R35.0","R35.1","R81","R82.998","R31.9","Z79.899","R33.9","R39.198","N39.0","Z12.5","R31.29","Z00.01","F41.8","E11.9","B35.1","B20","R76.8","W12.XXXA","F11.20","F32.2","E11.69","L85.3","N30.00","S09.90XA","S13.120A","M47.812","S39.91XA","J18.1","K44.9","K80.20","N28.1","S02.831A","J90","M84.48XA","J98.11","I49.1","S61.411A","Z21","F32.9","S22.41XD","E78.5","N52.9","S49.92XA","J30.2","Z28.21","I48.91","Z51.81","Z00.00","M41.9","H25.813","E80.6","F34.9","F41.9","Z77.22","S19.9XXA","R91.8","R09.89","S22.41XA","S13.100A"],"date":["2021-04-18","2021-03-23","2021-05-05","2019-12-22","2019-12-22","2019-12-22","2020-12-10","2021-02-02","2020-12-10","2020-12-10","2021-03-03","2020-12-10","2021-02-02","2020-12-10","2020-12-10","2021-03-17","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-03-31","2021-03-03","2021-03-31","2021-03-31","2021-03-31","2021-03-31","2019-09-19","2019-09-19","2020-07-07","2021-02-02","2019-10-07","2019-10-07","2019-12-21","2020-08-12","2020-11-29","2021-02-02","2021-02-02","2021-02-02","2019-12-21","2019-12-22","2019-12-21","2019-12-21","2019-12-21","2019-12-21","2019-12-21","2019-12-21","2019-12-22","2019-12-22","2019-12-22","2019-12-22","2019-12-22","2019-12-22","2019-12-22","2019-12-22","2019-12-22","2020-07-07","2019-04-10","2019-12-21","2020-11-03","2020-11-03","2021-03-17","2019-05-06","2019-09-19","2020-07-07","2020-07-07","2020-12-10","2019-12-02","2019-12-02","2019-12-02","2019-12-21","2019-12-22","2019-12-22","2019-12-21","2019-12-22"],"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":[["","00378425001","DOXEPIN ","CAP 50MG","30","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","30","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","100","Select","Select",""],["","49348098023","SM ","TAB 81MG EC","90","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","65162063709","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00378718705","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","65862020390","LOSARTAN ","TAB 100MG","30","Select","Select",""],["","69618004610","ASPIRIN ","TAB 81MG EC","90","Select","Select",""],["","43547040710","CLONAZEPAM ","TAB 1MG","60","Select","Select",""],["","57237000830","MIRTAZAPINE ","TAB 15MG","15","Select","Select",""],["","57896044101","BISACODYL ","TAB 5MG EC","4","Select","Select",""],["","11822511120","RA ","TAB 5MG","30","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","90","Select","Select",""],["","45802086802","POLYETH ","POW 3350 NF","238","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":""}]}]}