{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANDY GILLISPIE","gend":0,"add":"701 HOLLINS STREET","city":"LYNCHBURG","state":"VA","zip":"24504-2254","dob":"1956-01-18","age":"","mstatus":"","insh":10052640,"cliId":"","pno":4342213350,"cno":4342213350,"email":"","ename":"","eno":"","pphy":"WRIGHT, RONNA K","ppno":4345822273,"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":"APT 402","add3":"","madd1":"701 HOLLINS STREET","madd2":"APT 402","madd3":"","mcity":"LYNCHBURG","mstate":"VA","mzip":"24504-2254","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J32.9","R09.81","I25.10","E11.9","I10","I25.2","Z86.73","Z95.5","Z79.84","F17.210","E11.51","I70.211","Y71.8","I70.92","I70.8","Z95.820","T82.858A","I45.10","E78.5","Z72.89","M79.672","M79.671","Z11.59","R07.9","Z79.02","Z79.82","Z79.899","I73.9","I21.9","I63.9","F17.200","L97.512","E11.42","B35.1","L84","L60.3","L03.115","R68.89","R19.5","I70.202","Z20.828","E11.65","M10.9","N40.1","E78.2","E11.59","Z12.5","Z13.9","Z12.11","R09.89","K63.89","K57.30","I45.2","F41.1","N52.9","L98.9","F32.0","J44.9","Z68.23","J98.9","R05","M20.12","E11.621","L97.519","L85.3","H26.492","Z71.3","M79.605","I70.293","Z72.0","Z23","N42.9","I49.9","R09.02","R00.0","T15.11XA","B07.9","Z01.812","R60.9"],"date":["2019-07-04","2019-07-04","2019-07-04","2020-07-24","2021-04-06","2020-08-21","2020-07-23","2019-07-04","2020-08-21","2020-08-21","2020-07-23","2020-08-21","2019-07-25","2020-08-21","2019-07-25","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2019-07-25","2019-09-23","2019-09-23","2020-05-16","2021-04-06","2020-07-23","2020-08-21","2020-07-23","2021-01-26","2020-07-24","2020-07-24","2020-07-24","2019-10-07","2020-08-21","2020-10-29","2020-10-29","2020-10-29","2019-10-07","2021-02-04","2020-05-19","2020-08-21","2020-08-21","2021-04-06","2021-01-26","2021-01-26","2019-08-05","2019-08-05","2019-08-05","2019-08-19","2020-02-13","2020-07-24","2020-05-19","2020-05-19","2021-04-06","2020-10-13","2019-02-04","2019-02-04","2019-02-04","2019-02-04","2019-02-04","2019-07-04","2019-07-04","2019-09-05","2019-09-05","2019-09-05","2020-10-29","2020-08-26","2019-12-10","2020-03-26","2019-05-09","2020-01-21","2021-01-26","2019-08-05","2020-07-23","2020-07-23","2020-07-23","2020-08-26","2020-10-13","2019-07-12","2020-07-23"],"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":[["","68180051901","LISINOP\/HCTZ ","TAB 20-12.5","60","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","10572010101","PEG-3350 ","SOL ELECTROL","4,000.00","Select","Select",""],["","62175089241","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","60","Select","Select",""],["","65862035790","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","59779060014","ASPIRIN ","TA B EC","30","Select","Select",""],["","57664016658","METOPROL ","TAB 50MG","180","Select","Select",""],["","00378641001","DOXEPIN ","CAP 100MG","30","Select","Select",""],["","68382075810","METFORMIN ","TAB 500MG","60","Select","Select",""],["","16714008210","HYDROXYZ ","TAB 25MG","120","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","67877012450","SILVER ","CRE 0.01","50","Select","Select",""],["","00193708050","CONTOUR ","TES BLD GLUC","50","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","67253090150","ALPRAZOLAM ","TAB 0.5MG","90","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","70461031903","FLUCLVX ","INJ 2019-20","0.5","Select","Select",""],["","59762330403","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","45802049326","AMMONIUM ","CRE 0.12","385","Select","Select",""],["","00378013710","ALLOPURINOL ","TAB 100MG","60","Select","Select",""],["","43386009019","GAVILYTE-G ","SOL ","4,000.00","Select","Select",""],["","00536379001","VITAMIN ","CAP 2000UNIT","30","Select","Select",""],["","45802011222","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 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":[[["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":""}]}]}