{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARLOS   B JONES","gend":0,"add":"C\/O MPU 2005382                                             ","city":"RICHMOND                      ","state":"VA","zip":"23225-5644","dob":"1988-10-12","age":"","mstatus":"","insh":10056088,"cliId":"","pno":2766731258,"cno":2766731258,"email":"","ename":"","eno":"","pphy":"TWANA, FARAJ                                                ","ppno":"","pcpadd":"1107 Brookdale St # A,SUITE 801","pcpcity":"Martinsville                  ","pcpstate":"VA","pcpzip":241124501,"pcpcounty":"","pcpid":"P0117725","pcpname":"CARILION MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"6900   ATMORE DRIVE                                         ","add3":"","madd1":"C\/O MPU 2005382                                             ","madd2":"6900   ATMORE DRIVE                                         ","madd3":"","mcity":"RICHMOND                      ","mstate":"VA","mzip":"23225-5644","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z51.81","M54.9","M79.606","R56.9","M54.30","G47.00","G89.4","G40.909","F90.1","F31.9","Z87.891","E08.65","E78.5","L21.9","M54.32","E78.49","E66.8","M62.838","Z23","H54.61","H53.121","G40.209","G47.9","K21.9","L84","E11.65","F31.89","J30.9","R21","L29.9","M48.062","G44.89","M54.2","M54.89","M54.5","M54.42","G89.29","R26.2","Z86.16","Z79.84","M54.41","R29.898","R20.0","M79.605","M86.9","I10","M47.816","E11.628","M79.89"],"date":["2019-07-11","2019-08-23","2019-01-11","2021-06-01","2019-02-05","2019-02-05","2019-05-10","2021-11-11","2019-08-23","2021-06-01","2021-04-30","2021-11-11","2021-04-30","2021-04-30","2019-05-22","2021-11-11","2021-11-11","2019-06-17","2019-08-06","2019-08-06","2019-08-06","2019-08-23","2019-08-23","2021-04-30","2019-11-26","2021-06-01","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2021-08-01","2021-04-30","2021-06-23","2021-11-11","2021-06-23","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-05-19","2021-08-01","2021-05-19","2021-06-23","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11"],"priorHcc":["","","","","","","",null,"","","",null,"","","",null,null,"","","","","","","","","","","","","","","","",null,"","","","","","","","","","",null,null,null,null,null]}},{"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":[["","55111053401","DIVALPROEX","500MG ER","60","Select","Select",""],["","60505014201","GLIPIZIDE","10MG","30","Select","Select",""],["","00310653004","BYDUREON","2MG","4","Select","Select",""],["","00193707025","CONTOUR","BLD GLUC","50","Select","Select",""],["","65862069201","PHENYTOIN","100MG","90","Select","Select",""],["","51991074890","DULOXETINE","60MG","30","Select","Select",""],["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","45802065078","LORATADINE","10MG","90","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","360","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","180","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","90","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","42","Select","Select",""],["","45802043803","HYDROCORT","1%","28","Select","Select",""],["","00006011231","JANUVIA","50MG","30","Select","Select",""],["","65862020190","LOSARTAN","25MG","30","Select","Select",""],["","49884005601","IMIPRAM","50MG","60","Select","Select",""],["","80777027398","MODERNA","COVID-19","0.5","Select","Select",""],["","00172392670","DIAZEPAM","5MG","2","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","48","Select","Select",""],["","55111053401","DIVALPROEX ","TAB 500MG ER","60","Select","Select",""],["","60505014201","GLIPIZIDE ","TAB 10MG","30","Select","Select",""],["","00310653004","BYDUREON ","INJ 2MG","4","Select","Select",""],["","00193707025","CONTOUR ","TES BLD GLUC","50","Select","Select",""],["","65862069201","PHENYTOIN ","CAP 100MG","90","Select","Select",""],["","51991074890","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","69097015907","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","90","Select","Select",""],["","45802046564","KETOCONAZOLE ","SHA 0.02","360","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","180","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","42","Select","Select",""],["","45802043803","HYDROCORT ","CRE 0.01","28","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","28","Select","Select",""],["","00006011231","JANUVIA ","TAB 50MG","30","Select","Select",""],["","65862020190","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","49884005601","IMIPRAM ","TAB 50MG","60","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","2","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","48","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","",""],["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":""}]}]}