{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESA   J GILLIAM","gend":1,"add":"328 14TH STREET NW","city":"NORTON","state":"VA","zip":"24273-1622","dob":"1957-05-10","age":"","mstatus":"","insh":10060013,"cliId":"","pno":2765964364,"cno":2765964364,"email":"","ename":"","eno":"","pphy":"BASHAM, CHRISTOPHER M","ppno":2766790321,"pcpadd":"295 Wharton Ln NE, ","pcpcity":"Norton","pcpstate":"VA","pcpzip":242731541,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":2762070687,"add2":"                                                            ","add3":"","madd1":"328 14TH STREET NW","madd2":"                                                            ","madd3":"","mcity":"NORTON","mstate":"VA","mzip":"24273-1622","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.641","I10","F41.9","E55.9","N32.81","N39.0","Z01.419","R10.2","N39.41","G47.33","G40.209","N39.490","E03.9","M10.061","E88.81","D58.2","E78.2","M25.50","E78.00","Z12.31","Z68.41","R73.09","E11.9","M79.671","M21.611","L84","M21.612","M19.90","E78.1","R73.9","Z71.89","M79.7","R20.0","M79.643","R20.2","M77.32","M79.672","M19.041","E04.2","H40.1131","L71.8","Z80.3","E66.01","L57.0","S00.30XA","D48.5","R13.10","R76.8","M19.072","M19.071","L82.1","L81.4","D22.62","Z12.11","R10.31","Z90.721","E11.00","E11.40","K21.9","Z86.010"],"date":["2019-01-11","2021-05-13","2021-04-05","2021-04-05","2020-08-31","2020-08-31","2019-11-01","2019-11-01","2019-12-26","2021-04-05","2020-10-07","2020-12-30","2021-04-05","2019-07-09","2021-03-29","2019-07-09","2021-03-29","2019-07-09","2021-04-05","2020-11-18","2019-07-09","2019-07-09","2021-04-05","2019-09-23","2019-09-23","2019-09-23","2019-09-23","2021-04-05","2020-11-23","2020-07-27","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2019-01-11","2019-01-11","2019-01-11","2020-02-05","2021-04-20","2020-07-30","2019-09-24","2020-12-03","2019-10-28","2019-10-28","2019-10-28","2020-05-13","2019-01-10","2019-01-11","2019-01-11","2020-07-30","2020-07-30","2020-07-30","2019-10-09","2019-11-01","2019-11-01","2020-01-07","2020-01-07","2020-05-13","2020-05-13"],"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":[["","00169406012","VICTOZA ","INJ 18MG\/3ML","6","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","00832003800","OXYBUTYNIN ","TAB 5MG","90","Select","Select",""],["","60505257808","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","00904671746","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","57237001999","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","16729041501","DOXAZOSIN ","TAB 8MG","60","Select","Select",""],["","00168032346","METRONIDAZOL ","CRE 0.0075","45","Select","Select",""],["","61314022605","TIMOLOL ","SOL 0.25% OP","5","Select","Select",""],["","00143980350","DOXYCYCL ","CAP 100MG","30","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","80681013100","VITAMIN ","CAP 5000UNIT","30","Select","Select",""],["","45802004064","SELENIUM ","LOT 0.025","118","Select","Select",""],["","60505265601","TRIAMT\/HCTZ ","TAB 37.5-25","30","Select","Select",""],["","00169185550","NOVOFINE ","MIS 32GX4MM","100","Select","Select",""],["","00378181310","LEVOTHYROXIN ","TAB 125MCG","30","Select","Select",""],["","00078051205","TEGRETOL-XR ","TAB 400MG","120","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","57896022201","ACETAMINOPHE ","TAB 500MG","100","Select","Select",""],["","00023921110","COMBIGAN ","SOL 0.2\/0.5%","10","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","TES LITE","50","Select","Select",""],["","62756014202","METFORMIN ","TAB 500MG ER","30","Select","Select",""],["","00904672080","ACETAMIN ","TAB 500MG","100","Select","Select",""],["","51672412501","CARBAMAZEPIN ","TAB 400MG ER","120","Select","Select",""],["","70000004701","ALL ","TAB 10MG","30","Select","Select",""],["","00002143380","TRULICITY ","INJ 0.75\/0.5","2","Select","Select",""],["","00168020230","CLINDAMYCIN ","GEL 0.01","30","Select","Select",""],["","43547040711","CLONAZEPAM ","TAB 1MG","60","Select","Select",""],["","08222095831","PEN  NEEDLES  ","MIS 31GX8MM","100","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","16714029904","AMOXICILLIN ","500MG","30","Select","Select",""],["","65162046650","IBUPROFEN ","800MG","30","Select","Select",""],["","31722070190","LOSARTAN ","50MG","90","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":""}]}]}