{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL   A BOWMAN","gend":0,"add":"150   SERENE COURT                                          ","city":"CASCADE                       ","state":"VA","zip":"24069-3452","dob":"1971-04-19","age":"","mstatus":"","insh":10051034,"cliId":"","pno":4347109813,"cno":4347109813,"email":"","ename":"","eno":"","pphy":"TRIVEDI, RAJENDRA S                                         ","ppno":"","pcpadd":"501 Rison St","pcpcity":"Danville                      ","pcpstate":"VA","pcpzip":245412426,"pcpcounty":"","pcpid":"P0060294","pcpname":"MEMORIAL FAMILY CARE INC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APARTMENT 32B                                               ","add3":"","madd1":"150   SERENE COURT                                          ","madd2":"APARTMENT 32B                                               ","madd3":"","mcity":"CASCADE                       ","mstate":"VA","mzip":"24069-3452","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.31","F25.0","Z00.01","B88.9","J30.9","E66.01","F25.9","F41.9","R45.6","E11.9","I10","Z79.4","G47.30","F99","G20","E11.40","Z68.41","Z91.14","R74.8","E83.42","Z23","M54.9","F10.11","D53.9","Z60.4","F20.3","F32.9","E66.9","R68.89","F31.5","R42","Z88.0","Z79.84","Z79.899","I95.9","R44.3","E10.9","D64.9","F31.9","G47.33","T14.8XXA","K59.00","K62.5","Z79.1","R53.1","M62.81","K92.2","B99.9","Z13.6","Z11.4","Z76.89","S80.869S","F33.2","R10.30","R19.7","R11.2","R10.84","R52","R11.11","R11.0","F25.1","M79.643","S62.632A","M79.644","W23.0XXA","S61.202A","S61.212A","M79.646","S62.622B","E66.3","S62.622D","D50.9","J30.2","Z13.29","K21.9","U07.1","J12.82","J96.01","N17.9","Z68.43","E11.65","R74.01","Z68.45","Z91.81","R06.00","R06.02","R25.1","R06.09","Z86.16","R94.31","I34.0","I37.1","I51.7","Z11.59","Z12.5","E78.2","R60.0","I82.411","I82.431","I87.2","M79.662","M79.661","R22.43","I82.409","L97.812","L97.822","I87.313","E11.622","I82.401","I87.8","Z83.3","I87.311"],"date":["2019-03-24","2019-03-20","2019-02-18","2019-02-18","2019-02-18","2021-11-29","2021-10-08","2020-05-17","2019-02-22","2021-10-08","2021-11-29","2020-03-05","2021-11-12","2021-03-29","2020-01-06","2021-11-12","2019-02-23","2019-02-23","2019-02-23","2019-02-23","2020-11-24","2019-02-23","2019-02-23","2019-02-23","2019-02-23","2021-11-08","2019-02-25","2019-02-25","2020-05-05","2019-09-19","2019-08-16","2021-11-12","2021-11-12","2019-06-21","2020-01-06","2019-06-21","2020-03-12","2021-11-12","2021-03-01","2021-11-29","2019-08-16","2020-01-06","2019-08-16","2019-08-16","2019-08-16","2019-08-17","2019-08-17","2019-08-16","2019-08-20","2019-08-20","2019-08-20","2019-08-20","2020-05-17","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2020-03-05","2020-01-06","2020-01-06","2021-10-19","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-13","2020-03-20","2020-03-13","2020-04-03","2021-10-08","2021-10-08","2020-05-07","2021-10-08","2021-03-05","2021-03-04","2021-03-05","2021-03-04","2021-11-29","2021-03-04","2021-03-01","2021-05-07","2021-11-29","2021-10-08","2021-06-25","2021-06-03","2021-06-22","2021-06-22","2021-06-22","2021-06-25","2021-06-25","2021-06-25","2021-08-18","2021-10-08","2021-10-08","2021-11-12","2021-10-19","2021-10-19","2021-11-12","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-11-17"],"priorHcc":["","","","","",null,"","","","",null,"",null,"","",null,"","","","","","","","","",null,"","","","","",null,null,"","","","",null,"",null,"","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","",null,"","","",null,"","","","","","","","","","","","",null,"","",null,"","",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":[["","46287000601","SPS","15GM\/60","180","Select","Select",""],["","67877019805","AMLODIPINE","5MG","28","Select","Select",""],["","59148007280","ABILIFY","400MG","1","Select","Select",""],["","71093013205","METFORMIN","500MG","30","Select","Select",""],["","43547035411","LISINOPRIL","20MG","30","Select","Select",""],["","64980043810","ATENOLOL","50MG","30","Select","Select",""],["","76385010410","BENZTROPINE","1MG","60","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","67877022301","GABAPENTIN","300MG","56","Select","Select",""],["","43547028211","ESCITALOPRAM","20MG","28","Select","Select",""],["","68382041205","OMEPRAZOLE","20MG","28","Select","Select",""],["","50111056102","TRAZODONE","100MG","28","Select","Select",""],["","45802065087","LORATADINE","10MG","28","Select","Select",""],["","00781538192","ATORVASTATIN","10MG","28","Select","Select",""],["","69230031203","ALLERGY","10MG","30","Select","Select",""],["","67877043203","ARIPIPRAZOLE","10MG","14","Select","Select",""],["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","57237023305","SMZ-TMP","800-160","14","Select","Select",""],["","62332042631","BENZONATATE","100MG","30","Select","Select",""],["","65862017760","CEFDINIR","300MG","6","Select","Select",""],["","00904672559","SENNA","8.6MG","14","Select","Select",""],["","42571025101","CLINDAMYCIN","150MG","40","Select","Select",""],["","46287000601","SPS ","SUS 15GM\/60","180","Select","Select",""],["","67877019805","AMLODIPINE ","TAB 5MG","28","Select","Select",""],["","59148007280","ABILIFY ","INJ 400MG","1","Select","Select",""],["","71093013205","METFORMIN ","TAB 500MG","30","Select","Select",""],["","43547035411","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","64980043810","ATENOLOL ","TAB 50MG","30","Select","Select",""],["","76385010410","BENZTROPINE ","TAB 1MG","60","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","67877022301","GABAPENTIN ","CAP 300MG","56","Select","Select",""],["","43547028211","ESCITALOPRAM ","TAB 20MG","28","Select","Select",""],["","68382041205","OMEPRAZOLE ","CAP 20MG","28","Select","Select",""],["","50111056102","TRAZODONE ","TAB 100MG","28","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","28","Select","Select",""],["","00781538192","ATORVASTATIN ","TAB 10MG","28","Select","Select",""],["","69230031203","ALLERGY ","TAB 10MG","30","Select","Select",""],["","67877043203","ARIPIPRAZOLE ","TAB 10MG","28","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","57237023305","SMZ-TMP ","TAB 800-160","14","Select","Select",""],["","62332042631","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","65862017760","CEFDINIR ","CAP 300MG","6","Select","Select",""],["","50458058451","XARELTO ","TAB 15\/20MG","51","Select","Select",""],["","00904672559","SENNA ","TAB 8.6MG","14","Select","Select",""],["","42571025101","CLINDAMYCIN ","CAP 150MG","40","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":""}]}]}