{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DENNIS   E POWELL","gend":0,"add":"7559 LOUISA RD","city":"GORDONSVILLE","state":"VA","zip":"22942-6427","dob":"1945-12-31","age":"","mstatus":"","insh":10052224,"cliId":"","pno":5404060652,"cno":5404060652,"email":"","ename":"","eno":"","pphy":"HAWKINS, ANDREW RICHARD","ppno":4346548900,"pcpadd":"29 Jefferson Ct, ","pcpcity":"Zion Crossroads","pcpstate":"VA","pcpzip":229429602,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"7559 LOUISA RD","madd2":"                                                            ","madd3":"","mcity":"GORDONSVILLE","mstate":"VA","mzip":"22942-6427","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.83","L57.0","D48.5","L85.3","L29.8","L82.1","L57.8","I25.10","I47.1","I10","A41.9","K85.10","I50.22","K83.09","K80.63","I11.0","Z20.828","E78.5","I27.20","D64.9","M19.90","K59.00","R06.02","J70.4","I42.8","R74.0","D72.829","R78.81","Z90.49","K86.89","R21","T22.251A","T21.21XA","J30.1","S29.9XXA","S89.92XA","S99.912A","M79.89","R10.9","R68.83","D72.825","R94.5","E80.7","L30.0","L30.9","L01.00","S82.832A","M62.838","R07.9","K80.20","I25.110","R50.9","S40.811A","S40.812A","J45.909","E78.00","S36.112A","S93.402A","V03.10XA","M54.5","R14.3","R00.0","I49.9","V09.1XXA","Y93.89","Y99.8","Z87.891","I25.119","Z95.1","K76.89","K57.10","J98.4","T85.590A","Y83.1","R00.1","K86.9","K76.0","B96.20","R30.0","T22.191A","X16.XXXA","S59.912A","S82.452A","R94.31","K80.43","K40.90","T22.051A","X17.XXXA","T31.11","T30.0","R42","I50.20","J30.2","I47.2","K80.10","K83.8","R91.8","K63.89","R19.8"],"date":["2019-03-13","2019-05-29","2019-05-29","2019-05-29","2019-05-29","2019-03-13","2021-03-26","2020-08-31","2020-02-03","2021-05-06","2020-08-13","2020-08-13","2020-08-29","2020-09-08","2020-08-02","2020-08-29","2020-08-29","2020-08-29","2020-08-02","2020-09-08","2020-08-02","2020-08-05","2020-08-29","2020-08-02","2020-08-03","2020-08-05","2020-08-05","2020-09-01","2020-08-31","2020-09-01","2021-03-18","2019-09-12","2019-09-12","2019-10-23","2020-01-03","2020-01-03","2020-01-03","2020-01-03","2020-08-29","2020-08-30","2020-08-29","2020-08-29","2020-08-30","2021-03-26","2021-03-26","2021-03-26","2020-01-10","2020-01-10","2020-08-31","2020-08-03","2021-05-06","2020-08-28","2019-05-29","2019-05-29","2019-07-05","2020-02-03","2020-01-03","2020-01-02","2020-01-02","2020-01-10","2020-08-04","2020-08-31","2019-11-06","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2020-02-03","2020-08-29","2020-08-29","2020-08-29","2020-08-29","2020-08-29","2020-08-29","2020-08-29","2020-08-29","2020-08-29","2020-08-29","2021-05-06","2019-09-12","2019-09-12","2020-01-03","2020-01-03","2020-02-03","2020-08-03","2021-03-18","2019-09-12","2019-09-12","2019-09-12","2019-09-12","2019-10-26","2019-10-26","2019-10-26","2019-10-26","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03"],"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":[["","00093317431","ALBUTEROL ","FAT E HFA INH","8.5","Select","Select",""],["","76385011050","CARVEDILOL ","TAB 3.125MG","60","Select","Select",""],["","00536123441","ASPIRIN ","TAB 81MG EC","90","Select","Select",""],["","60505294509","EZETIMIBE ","TAB 10MG","30","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","15","Select","Select",""],["","68462029017","AUG ","CRE 0.0005","60","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","64980016401","RISA-BID ","TAB PROBIO","20","Select","Select",""],["","68180071909","AMLODIPINE ","TAB 2.5MG","30","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","18","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","68180051303","LISINOPRIL ","TAB 5MG","60","Select","Select",""],["","70377002711","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","50428482014","ANTI-ITCH ","LOT SENS 1%","222","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","70377000712","ROSUVASTATIN ","TAB 10MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","21922002107","PERMETHRIN ","CRE 0.05","60","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","50428026496","CVS ","TAB 8.6MG","30","Select","Select",""],["","45802041954","AMMONIUM ","LOT 0.12","225","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","67877031901","IBUPROFEN ","TAB 400MG","30","Select","Select",""],["","67877025145","TRIAMCINOLON ","CRE 0.001","454","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","21","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","20","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","00591215990","CICLOPIROX ","1%","120","Select","Select",""],["","00093321992","KETOCONAZOLE ","2%","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","",""],["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":""}]}]}