{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICIA   L WRIGHT","gend":1,"add":"6318 PHILBROOK ROAD                                         ","city":"RICHMOND                      ","state":"VA","zip":"23234-6257","dob":"1959-11-01","age":"","mstatus":"","insh":10050919,"cliId":"","pno":8043097406,"cno":8043097406,"email":"","ename":"","eno":"","pphy":"MULLET, EMILY K                                             ","ppno":"","pcpadd":"4730 N Southside Plaza St","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232241742,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"9051 Redbridge Rd                                           ","madd2":"                                                            ","madd3":"","mcity":"North Chesterfield            ","mstate":"VA","mzip":"23236-3423","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.09","J84.10","G47.33","R91.8","K21.9","E66.01","Z00.00","Z12.31","B00.2","I10","J47.9","R91.1","J98.4","J84.9","K13.0","I11.0","I50.32","M19.90","Z79.82","L98.8","M54.9","I50.30","R73.01","I50.9","T23.211A","R07.89","R10.9","R07.9","Z12.11","D12.5","K57.30","K64.8","K76.0","K80.20","D64.9","E55.9","H52.03","H52.4","E66.9","L60.9","R42","Z23","M54.16","M54.5","M51.36","R51.9","M06.9","Z78.9","R00.1","R00.0","R77.1","D89.0","R73.09","D89.2","R94.39","Z68.41","L98.9","R10.11","Z79.899","I87.2","I44.0","Z04.9","H90.41","B37.83","R10.12","Z68.44"],"date":["2019-01-03","2021-06-07","2021-04-15","2019-01-03","2021-10-24","2021-11-08","2020-06-09","2020-06-09","2019-02-12","2021-09-02","2019-03-05","2019-03-05","2021-10-24","2019-03-05","2021-07-06","2021-10-24","2021-10-24","2021-10-24","2021-10-24","2020-02-10","2019-08-14","2021-09-02","2021-06-07","2021-01-28","2019-10-21","2021-10-24","2020-03-10","2021-07-24","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2020-03-10","2020-05-04","2021-06-07","2021-02-09","2020-06-19","2020-06-19","2021-04-15","2020-10-12","2021-03-31","2020-10-07","2020-10-20","2020-11-13","2020-10-20","2021-07-29","2021-06-07","2021-01-28","2021-02-05","2021-02-05","2021-02-09","2021-02-09","2021-02-25","2021-06-07","2021-04-15","2021-11-08","2021-06-07","2021-06-07","2021-11-08","2021-07-06","2021-07-24","2021-07-24","2021-07-29","2021-10-22","2021-11-08","2021-11-08"],"priorHcc":["","","","","",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":[["","43386009019","GAVILYTE-G","","4,000.00","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00299391716","CETAPHIL","MOISTURE","454","Select","Select",""],["","68462016305","CARVEDILOL","6.25MG","180","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","90","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","43598081115","CETIRIZINE","10MG","90","Select","Select",""],["","00168014630","HYDROCORT","2.50%","28.35","Select","Select",""],["","00187137326","CERAVE","","340","Select","Select",""],["","51672128402","TRIAMCINOLON","0.10%","60","Select","Select",""],["","65862078330","ESOMEPRA","20MG DR","90","Select","Select",""],["","68462019005","NAPROXEN","500MG","60","Select","Select",""],["","23155050105","HYDROXYZ","25MG","40","Select","Select",""],["","11917010165","VITAMIN","1000UNIT","60","Select","Select",""],["","00456315467","AEROCHAMBER","PLUS","1","Select","Select",""],["","31604002683","D3","1000UNIT","180","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","15","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","10","Select","Select",""],["","43386009019","GAVILYTE-G ","SOL ","4,000.00","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00299391716","CETAPHIL ","CRE MOISTURE","454","Select","Select",""],["","68462016305","CARVEDILOL ","TAB 6.25MG","180","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","43598081115","CETIRIZINE ","TAB 10MG","90","Select","Select",""],["","00168014630","HYDROCORT ","OIN 0.025","28.35","Select","Select",""],["","00187137326","CERAVE ","CRE ","340","Select","Select",""],["","51672128402","TRIAMCINOLON ","OIN 0.001","60","Select","Select",""],["","65862078330","ESOMEPRA ","CAP 20MG DR","90","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","60","Select","Select",""],["","23155050105","HYDROXYZ ","TAB 25MG","40","Select","Select",""],["","11917010165","VITAMIN ","CAP 1000UNIT","60","Select","Select",""],["","00456315467","AEROCHAMBER ","MIS PLUS","1","Select","Select",""],["","31604002683","D3 ","TAB 1000UNIT","180","Select","Select",""],["","57237000630","FLUCONAZOLE ","TAB 200MG","4","Select","Select",""],["","45802004835","NYSTATIN ","OIN 100000","15","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","20","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","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","",""],["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":""}]}]}