{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAQUARIUS   O GOODE","gend":0,"add":"229 PATTESON SCHOOL ROAD                                    ","city":"APPOMATTOX                    ","state":"VA","zip":"24522-8662","dob":"1994-08-13","age":"","mstatus":"","insh":10051701,"cliId":"","pno":4348089202,"cno":4346075090,"email":"","ename":"","eno":"","pphy":"COMBS, KIMBERLY H                                           ","ppno":"","pcpadd":"2019 Tate Springs Rd Ste A","pcpcity":"Lynchburg                     ","pcpstate":"VA","pcpzip":245011131,"pcpcounty":"","pcpid":"P9058961","pcpname":"PIEDMONT FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"229 PATTESON SCHOOL ROAD                                    ","madd2":"                                                            ","madd3":"","mcity":"APPOMATTOX                    ","mstate":"VA","mzip":"24522-8662","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.9","F31.81","F40.10","F31.2","F41.1","F20.3","Z02.89","S82.842A","S99.912A","S82.845A","F25.0","R68.89","Z11.59","T84.84XA","F31.9","Z72.0","Z87.81","Z79.899","Z47.2","Z76.89","R53.83","Z13.220","Z13.228","Z11.4","Z78.9","Z71.2","R94.6","R79.89","Z71.3","E78.2","F19.10","E05.90","K40.91","D72.829","F29","M62.82","Z91.14","G93.40","N17.9","R41.0","G92","Z20.828","E86.0","F15.90","F60.9","Z82.49","Z80.9","Z81.8","Z91.19","Z91.83","R40.20","R41.82","R06.89","I10","F19.90","F23","K40.90","F15.10","F12.10","F17.210","Z56.0","E87.1","Z20.822","F41.9","R45.851","F15.251","F25.9","G47.00","Z91.5","I25.10","E78.5","R94.31","R65.10","D75.1","E83.52","R00.0","T43.621A","E87.2","E86.1","F12.20","E66.9","R10.31","Z53.20","Z68.24","S61.412A","W26.0XXA","Y92.89","F25.1","F33.1","S61.217A","X99.1XXA","S69.92XA","T76.11XA"],"date":["2020-09-02","2019-07-03","2019-07-03","2020-11-27","2019-04-05","2019-06-27","2019-06-27","2020-06-30","2020-03-17","2020-03-18","2021-10-28","2021-01-15","2020-07-22","2020-07-20","2020-09-02","2020-12-08","2020-07-20","2021-03-20","2020-07-20","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-09-02","2020-09-02","2020-09-02","2020-09-02","2020-09-02","2021-02-25","2020-09-15","2020-09-15","2020-11-29","2020-11-29","2021-02-27","2021-02-27","2020-11-29","2021-02-27","2021-02-24","2021-02-25","2020-11-27","2020-11-29","2021-02-27","2021-02-24","2020-11-27","2020-11-27","2020-11-27","2020-11-27","2020-11-27","2020-11-27","2021-02-24","2021-02-24","2021-01-10","2020-11-29","2021-02-25","2020-12-08","2021-01-14","2021-02-24","2021-05-25","2020-11-29","2021-02-25","2021-02-27","2021-01-09","2021-01-10","2021-01-10","2021-02-24","2021-01-10","2021-01-10","2021-01-10","2021-01-10","2021-01-11","2021-02-25","2021-02-24","2021-02-25","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2021-02-27","2021-02-27","2021-02-27","2021-02-27","2021-02-27","2021-05-25","2021-03-20","2021-05-25","2021-04-05","2021-04-09","2021-05-25","2021-05-25","2021-05-26","2021-05-26"],"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":[["","50458056401","INVEGA","234\/1.5","1.5","Select","Select",""],["","51293082001","METHIMAZOLE","5MG","30","Select","Select",""],["","13107004401","OXYCOD\/APAP","5-325MG","30","Select","Select",""],["","65862059501","DIVALPROEX","500MG ER","60","Select","Select",""],["","65862022701","LAMOTRIGINE","25MG","30","Select","Select",""],["","31722054501","LITHIUM","300MG","90","Select","Select",""],["","50111043303","TRAZODONE","50MG","30","Select","Select",""],["","43547034206","RISPERIDONE","2MG","60","Select","Select",""],["","50458056401","INVEGA ","INJ 234\/1.5","1.5","Select","Select",""],["","51293082001","METHIMAZOLE ","TAB 5MG","30","Select","Select",""],["","13107004401","OXYCOD\/APAP ","TAB 5-325MG","30","Select","Select",""],["","65862059501","DIVALPROEX ","TAB 500MG ER","60","Select","Select",""],["","65862022701","LAMOTRIGINE ","TAB 25MG","30","Select","Select",""],["","31722054501","LITHIUM ","CAP 300MG","90","Select","Select",""],["","50111043303","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","43547034206","RISPERIDONE ","TAB 2MG","60","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":""}]}]}