{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BILLY   G SHELTON","gend":0,"add":"4232 FRANKLIN TURNPIKE","city":"DANVILLE","state":"VA","zip":"24540-5246","dob":"1961-10-19","age":"","mstatus":"","insh":10052740,"cliId":"","pno":4348361908,"cno":"               ","email":"","ename":"","eno":"","pphy":"TRENT, STEPHEN","ppno":4347994488,"pcpadd":"201 S Main St Ste 3200, ","pcpcity":"Danville","pcpstate":"VA","pcpzip":245412932,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"4232 FRANKLIN TURNPIKE","madd2":"                                                            ","madd3":"","mcity":"DANVILLE","mstate":"VA","mzip":"24540-5246","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R39.81","Z23","R53.1","R09.02","R00.0","R41.82","F33.2","S40.022A","I10","F25.0","J44.9","K21.9","J96.00","F20.9","J09.X1","F41.1","J10.00","J96.21","J96.22","N39.0","E87.1","N17.9","E44.0","J44.1","F20.3","R26.2","I48.91","F79","R26.9","E83.39","E83.42","Z12.5","R68.89","I50.9","R06.09","I11.9"],"date":["2021-04-27","2021-04-15","2020-02-23","2020-02-23","2020-02-23","2020-03-14","2020-02-27","2020-08-05","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2020-03-13","2020-06-11","2020-02-23","2019-08-30","2020-02-28","2020-02-24","2020-02-24","2020-06-11","2020-02-24","2020-02-24","2020-02-24","2020-02-24","2020-02-24","2020-03-14","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-10-14","2020-03-13","2020-02-24","2020-02-24","2020-02-24"],"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":[["","29300013901","DIVALPROEX ","TAB 250MG DR","90","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","60","Select","Select",""],["","43547036109","LOSARTAN ","TAB 50MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00143312601","DICYCLOMINE ","CAP 10MG","60","Select","Select",""],["","43547034306","RISPERIDONE ","TAB 3MG","60","Select","Select",""],["","68180071909","AMLODIPINE ","TAB 2.5MG","30","Select","Select",""],["","33342017910","OLMESA ","TAB 20MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","13107008405","LORAZEPAM ","TAB 1MG","90","Select","Select",""],["","42806008301","BUSPIRONE ","TAB 7.5MG","60","Select","Select",""],["","68462018135","CLOTRIMAZOLE ","CRE 0.01","120","Select","Select",""],["","59779027408","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","59746036290","VALSARTAN ","TAB 160MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","70954006020","PREDNISONE ","TAB 20MG","5","Select","Select",""],["","57664047758","METOPROL ","TAB 50MG","30","Select","Select",""],["","00536589488","NICOTINE ","DIS 7MG\/24HR","28","Select","Select",""],["","00093117410","PENICILLN ","TAB 500MG","21","Select","Select",""],["","59779044374","CVS ","DIS 7MG\/24HR","28","Select","Select",""],["","00378021610","FUROSEMIDE ","40MG","30","Select","Select",""],["","53746051101","SPIRONOLACT ","25MG","15","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":""}]}]}