{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KELI   D WILLARD","gend":1,"add":"5907 BONNEAU ROAD","city":"RICHMOND","state":"VA","zip":"23227-2007","dob":"1980-10-20","age":"","mstatus":"","insh":10058152,"cliId":"","pno":8049445750,"cno":5405775621,"email":"","ename":"","eno":"","pphy":"JONES, BRITTANY DIXON","ppno":5407311600,"pcpadd":"3700 S Main St, ","pcpcity":"Blacksburg","pcpstate":"VA","pcpzip":240607017,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":8045855813,"add2":"                                                            ","add3":"","madd1":"2309 Courthouse Rd","madd2":"                                                            ","madd3":"","mcity":"North Chesterfield","mstate":"VA","mzip":"23236-1738","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","R10.9","R11.2","R19.7","T14.91XA","F31.9","G47.33","I10","E11.65","Z99.89","Z79.4","Z68.37","E11.42","F43.10","M79.7","Z68.39","U07.1","H92.02","R11.0","R51.9","J06.9","J44.9","G40.909","K21.9","F17.200","F32.9","Z79.84","Z86.010","Z80.0","G43.009","G62.9","M26.609","M79.641","S69.91XA","R10.31","R10.32","F60.3","R68.89","K22.70","K25.9","K52.9","K92.1","R10.30","E11.40","K42.9","K57.30","R07.9","R10.13","R10.11","K25.3","K44.9","M79.18","M50.30","D12.3","D37.4","G43.909","M06.9","E66.01","Z68.41","R00.0","R94.31","R11.10","R21","F17.210","Z79.899","I51.7","Z72.0","F43.12","R51","F33.9","R45.851","E78.5","F40.10","F41.0","Z81.8","K50.10","K25.4","Z68.38","R56.9","M54.2","M54.9","M54.6","Z71.89","K52.89","I25.2","Z86.73","Z85.41","R05","R10.84"],"date":["2020-11-19","2019-07-17","2019-12-01","2020-12-17","2019-10-28","2021-03-04","2019-11-26","2021-03-04","2021-03-04","2019-10-28","2019-12-01","2019-10-28","2019-12-17","2019-12-17","2019-12-17","2019-12-17","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-12-17","2020-11-02","2020-11-02","2020-11-02","2020-12-17","2020-12-17","2020-11-19","2021-03-04","2021-03-04","2021-04-05","2021-04-05","2019-07-17","2019-08-30","2019-10-05","2019-10-28","2019-11-26","2019-11-26","2019-11-26","2019-11-26","2019-11-26","2020-01-24","2019-02-08","2019-02-08","2019-02-08","2019-02-08","2019-02-08","2019-11-26","2019-11-26","2020-01-28","2020-01-28","2019-04-25","2019-04-25","2020-01-24","2019-04-25","2019-11-26","2019-07-24","2019-07-17","2020-09-11","2019-12-01","2019-12-01","2020-09-11","2019-12-01","2019-12-01","2019-07-24","2019-11-18","2020-09-11","2019-10-04","2019-10-04","2019-10-04","2019-10-04","2019-10-04","2019-10-04","2019-11-26","2019-11-26","2019-11-26","2019-11-26","2020-01-24","2020-01-24","2020-01-24","2020-11-02","2019-11-26","2020-09-11","2020-09-11","2020-09-11","2020-11-02","2020-12-17"],"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":[["","65862085901","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","6","Select","Select",""],["","62175030232","RABEPRAZOLE ","TAB 20MG","30","Select","Select",""],["","00169406013","VICTOZA ","INJ 18MG\/3ML","9","Select","Select",""],["","68382004101","PROMETHAZINE ","TAB 25MG","20","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","68645051654","AMLODIPINE ","TAB 10MG","15","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","67877022210","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","53746017801","METFORMIN ","TAB 500MG ER","60","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","30","Select","Select",""],["","00228212810","CLONIDINE ","TAB 0.2MG","30","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","68645055354","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","13","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","16729017217","AMITRIPTYLIN ","TAB 25MG","30","Select","Select",""],["","00006011231","JANUVIA ","TAB 50MG","90","Select","Select",""],["","08396901434","RELION ","MIS 32GX4MM","50","Select","Select",""],["","99073012050","FREESTYLE    TES","TES ","100","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","40","Select","Select",""],["","52817033010","CYCLOBENZAPR ","TAB 5MG","12","Select","Select",""],["","13107000334","MIRTAZAPINE ","TAB 30MG","30","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","68645056854","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","59746011506","PROCHLORPER ","TAB 10MG","12","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","00527058601","DICYCLOMINE ","CAP 10MG","15","Select","Select",""],["","47781072902","VANCOMYCIN ","CAP 125MG","112","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","52268001201","SUPREP ","SOL PREP KIT","354","Select","Select",""],["","00093221001","SUCRALFATE ","TAB 1GM","60","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":""}]}]}