{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" WILLIAM J GROGG JR","gend":0,"add":"DEBRA BAKER","city":"HINTON","state":"VA","zip":"22831-0122","dob":"1954-04-15","age":"","mstatus":"","insh":10052633,"cliId":"","pno":"5405603725, 5405603725","cno":"","email":"","ename":"","eno":"","pphy":"UNKNOWN PROVIDER QNXT PCP","ppno":"               ","pcpadd":"UNKNOWN STREET, ","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":232190000,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"WESTERN","aligned":"","ano":"","add2":"PO BOX 122","add3":"","madd1":"DEBRA BAKER","madd2":"PO BOX 122","madd3":"","mcity":"HINTON","mstate":"VA","mzip":"22831-0122","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J10.1","J45.901","N17.9","Z87.891","E11.621","L97.522","R06.02","Z79.4","L97.529","L97.524","M86.9","R68.89","S92.335A","M79.605","M79.672","M79.89","W17.89XA","I12.9","E11.22","N18.9","F17.210","Z89.412","Z89.422","Z88.8","Z88.2","R07.89","I49.3","I45.10","I44.0","R07.9","N18.30","I10","F17.200","E11.65","I65.23","N19","N20.0","E11.9","I25.10","I25.9","T83.511A","R50.9","Y84.6","A41.50","I50.22","I13.0","N39.0","B96.89","R31.9","F32.9","K21.9","I25.5","N18.31","J45.20","I25.810","E78.5","I48.92","E78.2","I26.93","I70.0","I51.7","T23.241A","T23.041A","X12.XXXA","T31.0","Z95.1","N18.4","J45.21","J44.1","J44.0","E11.40","E86.0","R33.9","R09.02","M19.90","L03.116","B95.62","B96.4","N40.0","N28.1","Z79.899","R60.0","L97.509","M62.81","E11.42","M79.674","Z23","Z91.89","R45.89","R42","N18.3","E11.8","L08.9","R06.9","I25.82","I42.9","Z72.0","I44.5","R30.0","N23","M17.12","M11.262","S86.112A","R33.8","R79.1","G47.00","Z87.448","K13.70","S80.822D","Z91.19","S98.132A","R00.0","S92.901G","R94.39","I47.2","F41.9","A41.51","R55","I20.8","R09.89","S29.9XXA","S89.92XA","S39.92XA","S09.90XA","S39.91XA","S39.93XA","L98.491","E11.628","I50.31","A41.9","R05","E08.621","J45.909","G89.29","M54.9","E78.6","R52","Z74.3","S92.332A","Z76.0","S61.432A","S69.92XA","W26.0XXA","Z01.818","E87.70","R45.0","R53.1","W19.XXXA","M79.662","M79.652","R90.82","R29.6","M86.8X7","L84","Z87.81","I70.208","I96","N17.0","M62.82","R41.0","N40.1","Z79.84","K05.319","S92.902A","I50.21","L97.528","E11.69","J44.9","E78.00","R79.89","E66.9","Z68.28","I27.20","U07.1"],"date":["2019-02-14","2019-02-14","2021-04-11","2021-03-16","2020-06-25","2019-06-11","2021-02-12","2021-01-22","2020-06-23","2019-08-21","2020-06-23","2020-03-14","2020-08-04","2020-08-04","2020-09-04","2020-10-07","2020-08-04","2021-03-16","2021-03-16","2021-03-16","2020-10-07","2020-09-08","2020-09-08","2021-03-16","2021-03-16","2021-01-22","2020-10-19","2020-10-21","2020-10-19","2021-03-12","2021-01-22","2021-01-22","2020-10-20","2020-10-23","2020-10-21","2020-10-25","2020-10-25","2021-01-22","2020-11-13","2020-11-01","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2021-04-11","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2021-03-12","2020-11-13","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-02-09","2021-03-12","2021-03-12","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2019-02-08","2019-02-14","2019-02-08","2019-02-08","2020-06-20","2019-02-14","2021-04-11","2020-06-28","2019-02-08","2020-06-23","2019-03-06","2019-03-06","2020-06-20","2020-03-28","2020-05-28","2020-08-04","2019-08-26","2019-08-26","2020-07-30","2020-03-05","2020-10-07","2020-03-05","2020-07-30","2021-04-11","2020-06-25","2020-06-12","2020-06-25","2020-06-28","2020-10-21","2020-10-20","2020-10-21","2020-10-21","2020-11-16","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2020-03-27","2019-06-11","2020-07-30","2020-07-30","2020-06-04","2020-06-23","2020-06-23","2020-07-30","2020-11-19","2020-08-26","2020-10-19","2020-10-22","2020-10-21","2020-11-16","2020-11-24","2021-01-22","2019-02-14","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2020-06-21","2020-06-25","2020-10-30","2020-11-13","2021-02-07","2019-06-11","2020-03-27","2020-05-28","2020-05-28","2019-07-15","2019-08-19","2019-08-19","2020-08-04","2020-09-08","2020-10-07","2020-10-07","2020-10-07","2020-10-21","2020-10-29","2020-11-19","2020-11-19","2020-11-19","2020-03-14","2020-03-14","2020-06-11","2020-06-11","2020-06-22","2020-09-04","2020-09-04","2020-09-04","2019-03-06","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2020-05-28","2020-08-07","2020-10-22","2019-08-19","2020-06-20","2020-06-20","2019-08-19","2020-06-20","2020-06-20","2020-06-20","2020-10-20","2021-02-12"],"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":[["","00193731150","CONTOUR ","TES NEXT","100","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","15","Select","Select",""],["","68462012605","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","75","Select","Select",""],["","13668011990","PIOGLITAZONE ","TAB 30MG","30","Select","Select",""],["","31722070730","FAMCICLOVIR ","TAB 250MG","60","Select","Select",""],["","65862069705","VENLAFAXINE ","CAP 150MG ER","30","Select","Select",""],["","65862047099","LOSARTAN\/HCT ","TAB 100-25","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","65862020190","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","69452014330","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","62756016013","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","16714048102","TRAMADOL ","TAB 50MG","20","Select","Select",""],["","00487980130","IPRATROPIUM ","SOL 0.02%INH","75","Select","Select",""],["","24658031205","DOXYCYCL ","TAB 100MG","10","Select","Select",""],["","00378699789","SODIUM ","NEB 0.03","1,080.00","Select","Select",""],["","56151210301","PEN  NEEDLES  ","MIS 31GX5\/16","100","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":""}]}]}