{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRUCE   L HARVILLE","gend":0,"add":"2342 HINESVILLE ROAD                                        ","city":"DANVILLE                      ","state":"VA","zip":"24541-7612","dob":"1977-07-11","age":"","mstatus":"","insh":10052505,"cliId":"","pno":4322286743,"cno":4322286743,"email":"","ename":"","eno":"","pphy":"WINFIELD II, ALBERT C","ppno":"","pcpadd":"441 Piney Forest Rd","pcpcity":"DANVILLE                      ","pcpstate":"VA","pcpzip":245404154,"pcpcounty":"","pcpid":"P9443093","pcpname":"PROVIDENCE FAMILY AND SPORTS MEDICINE INC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"2342 HINESVILLE ROAD                                        ","madd2":"                                                            ","madd3":"","mcity":"DANVILLE                      ","mstate":"VA","mzip":"24541-7612","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J02.9","J06.9","E66.3","Z68.29","M12.871","M12.872","M20.41","M20.42","M79.673","L84","G40.909","J30.9","G40.219","F31.9","F33.1","F70","K04.7","M79.672","R56.9","I10","Z71.3","Z68.30","Z13.89","M79.605","Z68.31","M54.30","M54.5","Z68.32","Z13.29","Z12.5","Z13.220","E66.9","L02.92","Z63.4","F07.81"],"date":["2019-03-05","2019-03-05","2019-03-05","2019-12-31","2019-07-09","2019-07-09","2019-03-28","2019-03-28","2019-05-16","2019-05-16","2021-05-25","2019-05-16","2021-10-21","2021-10-21","2021-10-21","2021-06-21","2019-10-16","2019-12-31","2019-10-16","2021-09-27","2021-09-27","2021-09-27","2019-12-31","2020-06-30","2021-05-25","2020-09-30","2021-02-25","2021-02-25","2021-05-25","2021-05-25","2021-05-25","2021-06-21","2021-09-27","2021-09-27","2021-10-21"],"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":[["","00496088215","LMX","4%","30","Select","Select",""],["","63402020660","APTIOM","600MG","30","Select","Select",""],["","55111015905","OMEPRAZOLE","40MG","30","Select","Select",""],["","00093506101","HYDROXYZ","25MG","60","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","67877019810","AMLODIPINE","5MG","30","Select","Select",""],["","43547028111","ESCITALOPRAM","10MG","30","Select","Select",""],["","62756079888","DIVALPROEX","500MG DR","60","Select","Select",""],["","10702000650","CYCLOBENZAPR","5MG","180","Select","Select",""],["","50488200401","LIDOCAINE","4%","10","Select","Select",""],["","00093274894","FAMOTIDINE","10MG","60","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","21","Select","Select",""],["","00143211205","DOXYCYCL","100MG","20","Select","Select",""],["","68462035801","NABUMETONE","500MG","30","Select","Select",""],["","00496088215","LMX ","CRE 0.04","30","Select","Select",""],["","63402020660","APTIOM ","TAB 600MG","30","Select","Select",""],["","55111015905","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00093506101","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","67877019810","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","43547028111","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","62756079888","DIVALPROEX ","TAB 500MG DR","60","Select","Select",""],["","10702000650","CYCLOBENZAPR ","TAB 5MG","180","Select","Select",""],["","50488200401","LIDOCAINE ","PAD 0.04","10","Select","Select",""],["","00143211205","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","00093274894","FAMOTIDINE ","TAB 10MG","60","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","68462035801","NABUMETONE ","TAB 500MG","30","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":""}]}]}