{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL   B VANCE","gend":0,"add":"417 NOTTINGHAM DRIVE","city":"COLONIAL HEIGHTS","state":"VA","zip":"23834-1139","dob":"1982-05-17","age":"","mstatus":"","insh":10050915,"cliId":"","pno":8048945096,"cno":"               ","email":"","ename":"","eno":"","pphy":"JOLANTA A HERRERA MD PLLC","ppno":8045267990,"pcpadd":"2552 Aldridge Ave, ","pcpcity":"South Chesterfield","pcpstate":"VA","pcpzip":238345306,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"11514 Doyle Rd","madd2":"                                                            ","madd3":"","mcity":"Dewitt","mstate":"VA","mzip":"23840-2104","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.21","R52","F31.60","F14.20","Z68.41","R45.851","I10","E78.00","K21.9","F17.210","E66.9","M79.671","F31.32","F32.9","F19.20","F17.209","N17.9","Z00.8","S41.111A","W26.8XXA","R51","G47.00","E55.9","E78.5","M54.5","F31.73","S39.91XA","S39.93XA","S09.90XA","R73.03","M62.830","F52.21","Z71.3","R10.9","Z79.891","Z68.45","F99","H53.149","F41.0","Z88.8","S09.93XA","R22.0","F17.200","Z68.42","M54.2","F33.1","F19.10","K13.79","R68.89","M25.511","G47.30","M72.2","E66.01","T79.7XXA","E11.9","T43.011A","K76.0","K85.00","R14.0","K86.1","F31.30","L23.9","M79.89","M77.31","Z79.1","Z00.01","G47.01","E78.2","W01.198A","H02.846","T14.90XA","W01.0XXA","J98.2","S19.9XXA","F25.0","T43.012A","D72.829","Z76.0","F31.9","X78.9XXA","M54.9","S51.811A","Z79.899","Z82.49","Z83.3","Z91.14","F22","F12.90","H57.12","X58.XXXA","Y92.89","F41.9","H02.844","H02.845","R40.2140","R40.2360","S05.12XA","W01.10XA","Z53.29","R91.8","S29.9XXA","E11.22","E11.42","T43.292A","I12.9","N18.9","G89.4","F90.9","F41.1","F31.4","R07.9","B34.9","G89.29","J01.90","Z11.59","E03.9","K85.90","Z88.6","Z90.49","F39","Z13.1","M25.571","Z13.220","T43.8X2A","T14.91XA","T50.901A","Z63.0"],"date":["2019-07-12","2020-10-10","2019-08-28","2019-07-20","2020-09-21","2020-09-22","2021-05-07","2021-02-23","2021-02-23","2021-02-23","2020-09-16","2019-08-26","2019-08-20","2020-09-22","2019-08-15","2019-08-15","2020-09-21","2019-08-15","2019-08-15","2019-08-15","2019-08-31","2020-01-17","2020-09-09","2021-02-23","2021-05-07","2020-02-25","2019-11-30","2019-11-30","2019-11-30","2021-03-09","2021-02-10","2020-12-08","2021-05-07","2021-02-24","2020-06-23","2019-04-17","2019-07-20","2019-08-31","2019-08-31","2021-02-23","2019-11-30","2019-11-30","2021-05-07","2020-07-23","2020-10-16","2020-09-28","2020-09-28","2020-10-07","2019-08-31","2019-04-17","2020-09-21","2019-08-14","2021-05-07","2019-11-30","2021-02-23","2020-09-22","2021-02-23","2021-02-23","2021-02-23","2021-02-24","2020-09-21","2020-01-17","2019-07-27","2019-07-27","2019-10-28","2019-09-26","2019-09-26","2019-09-26","2019-11-30","2019-11-30","2019-11-30","2019-11-30","2019-11-30","2019-11-30","2020-09-09","2020-09-21","2020-09-21","2019-07-18","2019-11-30","2019-08-15","2020-09-21","2019-08-15","2021-02-23","2019-08-15","2019-08-15","2019-08-15","2019-08-15","2019-11-30","2019-11-30","2019-11-30","2019-11-30","2019-11-30","2019-11-30","2019-11-30","2019-11-30","2019-11-30","2019-11-30","2019-11-30","2019-11-30","2019-11-30","2019-11-30","2020-09-21","2020-09-21","2020-09-21","2020-09-21","2020-09-21","2020-09-21","2020-09-21","2020-09-21","2020-09-09","2021-01-18","2021-01-18","2019-07-20","2019-12-05","2020-10-10","2021-02-23","2021-02-25","2021-02-23","2021-02-23","2021-02-23","2019-09-26","2019-07-24","2019-09-26","2020-09-21","2020-09-21","2020-09-21","2021-04-09"],"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":[["","50228017705","GABAPENTIN ","TAB 600MG","60","Select","Select",""],["","16729014801","QUETIAPINE ","TAB 200MG","30","Select","Select",""],["","62332001131","VENLAFAXINE ","TAB 75MG","60","Select","Select",""],["","00093005401","BUSPIRONE ","TAB 10MG","90","Select","Select",""],["","00591354160","BUPROPION ","TAB 150MG SR","60","Select","Select",""],["","60505017009","PRAVASTATIN ","TAB 40MG","30","Select","Select",""],["","57664050658","METOPROL ","TAB 25MG","60","Select","Select",""],["","43547035410","LISINOPRIL ","TAB 20MG","60","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","65162063709","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","67877056105","METFORMIN ","TAB 500MG","30","Select","Select",""],["","68180031906","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","63402030830","LATUDA ","TAB 80MG","90","Select","Select",""],["","11822068181","ALLERGY ","TAB 180MG","30","Select","Select",""],["","00591024110","LORAZEPAM ","TAB 1MG","60","Select","Select",""],["","00904671146","FEXOFENADINE ","TAB 180MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","12","Select","Select",""],["","00591321630","TESTOSTERONE ","GEL 1%(25MG)","75","Select","Select",""],["","59746017506","PREDNISONE ","TAB 20MG","11","Select","Select",""],["","27808015601","ROSUVASTATIN ","TAB 10MG","30","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","65862086001","FAMOTIDINE ","TAB 40MG","30","Select","Select",""],["","10702005601","OXYCODONE ","TAB 10MG","15","Select","Select",""],["","65162046650","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","67877021901","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","68180096701","LEVOTHYROXIN ","TAB 75MCG","30","Select","Select",""],["","00574061105","PODOFILOX ","SOL 0.005","3.5","Select","Select",""],["","00135057602","FLONASE ","SPR 50MCG","9.9","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","00603254421","BUT\/APAP\/CAF ","TAB ","10","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","10702000750","CYCLOBENZAPR ","TAB 10MG","60","Select","Select",""],["","51079062381","SULFAMYLON ","85MG\/GM","56.7","Select","Select",""],["","55111064501","OMEPRAZOLE ","40MG","30","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":""}]}]}