{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANDY   L DAVIS","gend":0,"add":"296 HORSESHOE ROAD","city":"APPOMATTOX","state":"VA","zip":"24522-4945","dob":"1965-11-17","age":"","mstatus":"","insh":10051736,"cliId":"","pno":4344209119,"cno":4344209119,"email":"","ename":"","eno":"","pphy":"BROSE, TEODORA G","ppno":4343528235,"pcpadd":"131 Jones St, ","pcpcity":"Appomattox","pcpstate":"VA","pcpzip":245229830,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"296 HORSESHOE ROAD","madd2":"                                                            ","madd3":"","mcity":"APPOMATTOX","mstate":"VA","mzip":"24522-4945","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.42","G43.909","I10","E78.5","L03.031","L03.032","E11.9","I25.10","J44.9","E11.65","E11.40","J45.998","R53.83","E11.36","H25.13","B35.1","L60.3","M25.751","M25.551","M51.36","L08.9","K21.9","G47.33","Z79.899","Z79.4","Z88.8","L03.039","Z68.41","E66.01","Z71.3","Z71.82","Z87.891","Z99.81","S90.01XA","Z79.51","Z88.5","W22.8XXA","Y92.89","M20.12","M79.89","M20.11","R42","R06.00","R07.9","M54.5","E56.8","N40.0","K56.609","I25.2","Z90.49","Z82.3","Z86.73","Z98.890","R68.89","Z53.21","M15.9","E66.09","I11.9","Z28.21","M25.571","Z23","S99.911A","R35.0","M51.37","R90.82","R90.89"],"date":["2019-07-09","2019-08-13","2021-05-04","2021-05-04","2019-07-24","2019-07-24","2021-05-04","2021-05-04","2021-05-04","2021-03-08","2020-10-27","2020-10-27","2020-10-27","2021-01-05","2021-03-08","2019-07-30","2019-07-30","2019-07-16","2019-07-16","2019-07-16","2019-07-29","2021-05-04","2019-07-28","2021-05-04","2019-08-13","2019-07-28","2019-08-29","2020-10-27","2019-09-30","2020-10-27","2020-10-27","2020-10-27","2019-09-30","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2019-07-28","2019-07-28","2019-07-28","2019-08-13","2019-08-13","2019-08-13","2019-07-16","2019-07-16","2019-07-16","2019-07-24","2019-07-24","2019-07-24","2019-07-24","2019-08-13","2019-07-24","2019-08-12","2019-08-12","2020-10-27","2020-10-27","2019-08-13","2019-09-30","2021-05-04","2021-05-04","2021-05-04","2019-03-06","2019-07-16","2019-08-13","2019-08-13"],"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":[["","00088221905","LANTUS ","INJ 100\/ML","30","Select","Select",""],["","50428034618","ALCOHOL ","PAD 0.7","100","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","50","Select","Select",""],["","08396901534","RELION ","MIS 31GX6MM","50","Select","Select",""],["","50428016183","CVS ","CAP 2000UNIT","30","Select","Select",""],["","00378827052","ALBUTEROL ","NEB 0.00083","150","Select","Select",""],["","00378797052","IPRATROPIUM ","SOL 0.02%INH","187.5","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","31604002665","FISH ","CAP 1000MG","30","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","30","Select","Select",""],["","00378021610","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","69097081312","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","30","Select","Select",""],["","00173068220","VENTOLIN ","AER ","36","Select","Select",""],["","65162044210","MECLIZINE ","TAB 25MG","30","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","51672126302","NYSTAT\/TRIAM ","CRE ","90","Select","Select",""],["","57599000019","FREESTYLE    KIT SENSOR","KIT SENSOR","3","Select","Select",""],["","68382076010","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","81131031282","D3 ","CAP 2000UNIT","30","Select","Select",""],["","50428085942","PREP ","PAD ","100","Select","Select",""],["","00225052547","AYR ","GEL NASAL","14.1","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","08080575000","CURITY ","PAD ALCOHOL","100","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","50484001030","SANTYL ","OIN 250\/GM","30","Select","Select",""],["","08290326895","BD ","PAD SNGL USE","100","Select","Select",""],["","00536379001","VITAMIN ","CAP 2000UNIT","30","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","00781185220","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","00193658621","MICROLET ","LANCETS","100","Select","Select",""],["","42806016005","HYDROXYZ ","25MG","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":[[["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":""}]}]}