{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KERMIT   J WRIGHT","gend":0,"add":"1301 LIBERTY AVENUE","city":"HOPEWELL","state":"VA","zip":"23860-6102","dob":"1962-08-21","age":"","mstatus":"","insh":10051752,"cliId":"","pno":8045518913,"cno":8045518913,"email":"","ename":"","eno":"","pphy":"MOHIUDDIN, ABDUL","ppno":8044588583,"pcpadd":"1012 Winston Churchill Dr, ","pcpcity":"Hopewell","pcpstate":"VA","pcpzip":238605141,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":8046383137,"add2":"                                                            ","add3":"","madd1":"1301 LIBERTY AVENUE","madd2":"                                                            ","madd3":"","mcity":"HOPEWELL","mstate":"VA","mzip":"23860-6102","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T87.40","S71.101A","T81.31XA","Z89.611","Z86.718","F17.210","I73.9","Z98.62","R68.89","E11.622","L98.492","I25.10","I10","Z88.0","Z88.2","Z79.84","S61.401A","S71.001A","T87.89","E78.00","E11.9","Z12.5","K21.9","T87.41","Z45.2","T87.43","Z89.612","J06.9","R52","R07.0","R06.6","I25.2","Z79.899","R00.0","I51.7","R94.31","M00.061","R78.81","R01.1","Z09","T81.49XA","Z98.890","Z02.89","A41.9","M86.9","N18.3","E11.22","I15.0","E11.65","Z79.4","N18.31","L97.929","L97.323","M19.90","N18.9","I12.9","L97.322","Z89.511","Z79.82","L97.329","E11.621","L97.529","L97.112","I11.0","E11.40","M79.604","E78.5","F17.200","Z95.1","M25.572","M54.2","W18.30XA","S09.90XA","M25.522","W05.0XXA","Y92.009","Z22.322","E66.9","Z68.22","L97.812","S71.101D","T81.31XD","M79.651","L02.415","R07.89","F45.8","I42.8","R94.30","Z51.89","M79.89","M79.601","W50.1XXA","M79.631","R60.0","E87.2","N25.89","D64.9","M85.80","E87.5","L97.321","G62.9","S06.9X9A","Z04.3","M79.661","S09.8XXA","S88.911A","R26.9","R29.6","T87.44","M62.81","E11.69","S30.0XXA","M54.5","N17.9","N18.30","R80.9","R79.89","S91.102A","Y83.5","G89.29","M54.9","Z79.2","Z51.81","M25.521","D72.829","R26.0","E11.3393","H25.13","E09.621","L97.405","Z72.0","R07.9","J90","E87.1","I42.9","E11.628","L08.9","R27.0","R09.89","E11.51","L60.3","L97.328","Z89.519","I45.19","I45.9","R14.2","K80.20","S89.92XA","V89.2XXA","S05.02XA","E53.8","E55.9","Z11.59","M54.6","M43.16","S39.92XA","I50.23","I13.0","S81.801A","Z68.23","L97.325","L97.522","X50.1XXA","L97.819","M79.9","Z01.810","Z95.5","S59.901A","S80.10XA","M79.605","V59.9XXA","Y99.0","S80.12XA","S80.11XD","S29.9XXA","D63.8","I77.89","T81.40XA","T87.9","H57.89","V48.4XXA","Y93.I9","Z23","S59.911A","S88.011A","S00.83XA","S60.221A","E13.621"],"date":["2020-11-02","2020-05-30","2020-05-30","2021-05-19","2020-05-30","2021-05-19","2021-05-05","2020-05-30","2021-02-24","2021-05-19","2019-05-08","2021-05-19","2021-03-31","2021-02-17","2019-10-31","2021-05-12","2021-04-07","2019-04-17","2020-11-02","2021-03-31","2021-03-31","2020-10-22","2021-05-19","2019-09-09","2019-11-11","2020-12-09","2019-09-11","2019-09-28","2019-09-28","2019-09-28","2019-09-28","2021-05-19","2021-05-12","2019-09-30","2019-09-30","2019-09-30","2019-10-31","2019-10-03","2019-10-03","2020-11-13","2019-11-04","2020-08-10","2019-11-04","2020-02-16","2020-02-19","2020-08-10","2021-05-19","2020-02-19","2021-04-07","2021-05-19","2020-12-04","2021-04-29","2021-05-05","2021-05-19","2021-05-19","2021-05-19","2021-04-07","2021-03-03","2021-05-19","2021-05-19","2021-05-05","2021-04-29","2019-02-06","2019-02-06","2019-02-26","2020-02-10","2020-11-02","2021-05-05","2020-06-13","2019-04-26","2019-05-29","2019-05-15","2019-05-29","2019-05-29","2020-10-22","2019-05-29","2019-06-08","2019-06-08","2019-06-08","2019-07-03","2019-08-29","2019-05-15","2019-08-07","2019-09-09","2019-09-23","2019-09-23","2019-10-01","2019-10-01","2019-10-16","2020-02-03","2020-07-13","2020-07-13","2020-07-13","2020-07-21","2020-12-16","2020-12-16","2020-10-22","2020-11-17","2021-01-04","2021-05-05","2019-02-26","2019-05-15","2019-05-29","2019-08-04","2019-05-29","2019-08-05","2021-01-20","2019-08-05","2019-08-05","2020-09-29","2020-02-16","2020-10-30","2020-10-30","2020-11-03","2020-12-16","2020-11-03","2021-01-04","2021-05-05","2020-11-02","2020-10-22","2020-01-06","2019-11-11","2019-11-05","2019-11-11","2021-05-03","2020-02-04","2020-07-08","2020-07-08","2020-12-31","2020-12-31","2020-12-31","2019-09-23","2019-09-23","2020-11-02","2019-09-29","2019-09-29","2019-09-29","2020-01-22","2021-02-09","2021-05-19","2021-05-05","2021-05-05","2019-09-14","2019-09-23","2019-09-23","2019-09-23","2019-09-30","2020-01-06","2020-01-06","2020-06-13","2020-10-22","2020-11-13","2020-10-22","2020-10-22","2020-10-22","2020-10-22","2020-11-03","2020-11-02","2020-11-02","2021-04-26","2021-04-28","2021-04-28","2019-04-26","2019-05-29","2019-06-08","2019-08-26","2019-08-26","2019-11-11","2020-01-06","2020-01-20","2020-01-06","2020-01-06","2020-01-06","2020-01-20","2020-10-22","2020-11-13","2019-03-27","2019-05-11","2019-08-07","2020-06-13","2020-06-13","2020-06-13","2020-06-13","2020-07-13","2021-01-20","2021-02-19","2021-02-19","2021-04-29"],"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":[["","00378021610","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","70377002711","ATORVASTATIN ","TAB 10MG","90","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","00006011231","JANUVIA ","TAB 50MG","30","Select","Select",""],["","65862053820","LEVOFLOXACIN ","TAB 750MG","14","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","00378235193","ESOMEPRA ","CAP 40MG DR","30","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","50","Select","Select",""],["","00093726710","METFORMIN ","TAB 500MG ER","120","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","90","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","00223172101","SODIUM ","TAB 650MG","90","Select","Select",""],["","10370074601","GLIPIZIDE ","TAB 10MG","30","Select","Select",""],["","69097096507","NABUMETONE ","TAB 500MG","60","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","68180065208","DOXYCYC ","CAP 100MG","28","Select","Select",""],["","57664037713","TRAMADOL ","TAB 50MG","14","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","28","Select","Select",""],["","45802004635","GENTAMICIN ","OIN 0.001","15","Select","Select",""],["","75834002001","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","50428085942","PREP ","PAD ","100","Select","Select",""],["","57896086501","ZINC ","TAB 220MG","7","Select","Select",""],["","80681002000","MULTIVITAMIN ","TAB ","30","Select","Select",""],["","08290491201","INSULIN ","MIS 1ML\/31G","30","Select","Select",""],["","00781591501","CHLORPROMAZ ","TAB 50MG","10","Select","Select",""],["","50428028552","ACETAMINOPHN ","TAB 500MG","30","Select","Select",""],["","24208091055","ERYTHROMYCIN ","OIN OP","3.5","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","57664050658","METOPROL ","TAB 25MG","60","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","10","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","200","Select","Select",""],["","67877041920","LINEZOLID ","TAB 600MG","28","Select","Select",""],["","46287000601","SPS ","SUS 15GM\/60","120","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","00093206406","CILOSTAZOL ","TAB 100MG","180","Select","Select",""],["","00406048410","APAP\/CODEINE ","TAB 300-30MG","15","Select","Select",""],["","00172392770","DIAZEPAM ","TAB 10MG","12","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","15","Select","Select",""],["","50428034618","ALCOHOL ","PAD 0.7","120","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","21","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","20","Select","Select",""],["","49884093547","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","10702005601","OXYCODONE ","10MG","12","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":""}]}]}