{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RUBY   J HAMLETT","gend":1,"add":"1508   LONGVIEW DRIVE                                       ","city":"LYNCHBURG                     ","state":"VA","zip":"24501-6354","dob":"1962-07-01","age":"","mstatus":"","insh":10053105,"cliId":"","pno":4343335727,"cno":4343335727,"email":"","ename":"","eno":"","pphy":"BOLUSA-SABUGO, AHGNES U                                     ","ppno":"","pcpadd":"320 Federal St","pcpcity":"Lynchburg                     ","pcpstate":"VA","pcpzip":245042306,"pcpcounty":"","pcpid":"P9058759","pcpname":"JOHNSON HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT 222                                                     ","add3":"","madd1":"1508   LONGVIEW DRIVE                                       ","madd2":"APT 222                                                     ","madd3":"","mcity":"LYNCHBURG                     ","mstate":"VA","mzip":"24501-6354","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","R10.9","Z87.19","M19.90","R94.4","R11.0","K59.00","K21.9","R10.84","R13.10","R63.4","R11.2","R19.8","K62.5","Z71.9","J45.909","R51","M25.562","M79.662","H57.12","H57.89","S05.02XA","H53.132","R73.09","H53.9","H25.13","H04.123","I10","F14.10","F20.9","M41.9","E07.9","Z79.899","R03.0","G44.89","Z76.0","M54.9","Z71.3","R40.0","R53.83","E55.9","E66.01","N28.9","I12.9","N18.30","N14.4","W19.XXXS","Z23","Z12.31","S80.01XA","M17.0","N18.2","M15.9","F43.10","M17.2","Z68.41","R60.9","R52","R11.11","R19.7","Z00.01","R39.9","R73.03","R22.0"],"date":["2021-03-11","2019-03-19","2019-03-19","2019-09-18","2019-03-19","2021-07-20","2020-08-10","2020-08-10","2021-07-20","2019-05-06","2019-05-06","2019-05-06","2019-05-06","2019-05-06","2019-05-06","2021-08-19","2019-09-18","2020-12-15","2019-07-03","2019-09-04","2019-09-04","2019-09-04","2019-09-04","2020-12-15","2019-09-17","2019-09-17","2019-09-17","2020-12-15","2019-09-18","2019-09-18","2019-09-18","2019-09-18","2019-09-18","2019-09-18","2019-09-18","2019-10-03","2021-03-11","2020-08-26","2020-08-26","2020-08-26","2021-08-19","2021-03-11","2020-09-15","2020-11-04","2020-11-04","2020-11-04","2020-12-15","2020-12-15","2020-12-15","2021-01-19","2021-01-19","2021-02-16","2021-03-11","2021-03-11","2021-04-13","2021-04-13","2021-04-13","2021-07-20","2021-07-20","2021-07-20","2021-08-19","2021-08-19","2021-08-27","2021-08-27"],"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":[["","45802008801","ALBUTEROL","HFA","8.5","Select","Select",""],["","53191036201","VITAMIN","50000UNT","4","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","52817036200","METOPROL","100MG","60","Select","Select",""],["","43547040111","FUROSEMIDE","20MG","30","Select","Select",""],["","68382003610","VENLAFAXINE","150MG ER","30","Select","Select",""],["","29300022010","MONTELUKAST","10MG","30","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","00186037220","SYMBICORT","80-4.5","10.2","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","90","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","16","Select","Select",""],["","68180047301","AMLOD\/BENAZP","10-40MG","30","Select","Select",""],["","62175013643","OMEPRAZOLE","40MG","30","Select","Select",""],["","51660033350","ARTHRTS","650MG","120","Select","Select",""],["","69842093108","ACETAMINOPHN","500MG","120","Select","Select",""],["","68462019005","NAPROXEN","500MG","60","Select","Select",""],["","71093011105","GABAPENTIN","600MG","90","Select","Select",""],["","00904673080","ACETAMIN","500MG","120","Select","Select",""],["","65862018730","ONDANSETRON","4MG","30","Select","Select",""],["","45802086803","POLYETH","3350 NF","510","Select","Select",""],["","57896026801","ACETAMINOPHE","650MG ER","120","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","00904198760","MAPAP","500MG","120","Select","Select",""],["","10572010001","PEG-3350","ELECTROL","4,000.00","Select","Select",""],["","57896020110","PAIN","500MG","120","Select","Select",""],["","45802008801","ALBUTEROL ","AER HFA","8.5","Select","Select",""],["","53191036201","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","52817036200","METOPROL ","TAB 100MG","60","Select","Select",""],["","43547040111","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","68382003610","VENLAFAXINE ","CAP 150MG ER","30","Select","Select",""],["","29300022010","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","51660033301","ARTHRTS ","TAB 650MG","120","Select","Select",""],["","68180047301","AMLOD\/BENAZP ","CAP 10-40MG","30","Select","Select",""],["","16714079904","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","62175013643","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00186037220","SYMBICORT ","AER 80-4.5","10.2","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","60432026415","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","69842093108","ACETAMINOPHN ","TAB 500MG","120","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","60","Select","Select",""],["","71093011105","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","00904673080","ACETAMIN ","TAB 500MG","120","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","45802086803","POLYETH ","POW 3350 NF","510","Select","Select",""],["","57896026801","ACETAMINOPHE ","TAB 650MG ER","120","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","00904198760","MAPAP ","CAP 500MG","120","Select","Select",""],["","10572010001","PEG-3350 ","SOL ELECTROL","4,000.00","Select","Select",""],["","57896020110","PAIN ","TAB 500MG","120","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":""}]}]}