{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY LASSITER","gend":1,"add":"WINTHROP MANOR ALF","city":"RICHMOND","state":"VA","zip":"23220-5856","dob":"1945-08-26","age":"","mstatus":"","insh":10063853,"cliId":"","pno":8042788982,"cno":8042788982,"email":"","ename":"","eno":"","pphy":"VCU CENTER FOR ADVANCED HEALTH","ppno":8042543500,"pcpadd":"MCV Physicians, 2116 W Laburnum Ave Ste 100","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232274359,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"2100 IDLEWOOD AVE.","add3":"","madd1":"WINTHROP MANOR ALF","madd2":"2100 IDLEWOOD AVE.","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23220-5856","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.9","F25.9","A41.89","J96.01","U07.1","J12.89","J44.0","J44.1","N28.9","E78.5","E11.9","Z79.84","D61.818","F17.210","F03.90","E87.0","R26.81","R63.0","R53.1","Z72.0","R54","R26.0","F20.0","E11.65","F20.5","S69.92XA","W01.0XXA","J98.11","N17.9","R09.02","R74.8","J44.9","F01.51","D50.9","S52.592D","S52.692D","M85.832","K80.20","R68.89","S52.502A","S52.602A","S52.692A","S52.592A","M25.539","G72.81","R53.81","B94.8","E55.9","F31.9","R05","R26.89","R45.87","R15.9","E78.2","S52.612A","S52.572A","M25.532"],"date":["2020-12-18","2020-01-13","2020-12-03","2020-12-28","2020-12-28","2020-12-03","2020-12-03","2020-12-17","2020-12-03","2020-12-26","2020-12-19","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2020-12-17","2020-12-17","2020-12-20","2020-12-20","2020-12-28","2020-12-29","2019-03-11","2019-12-28","2019-12-28","2020-12-06","2020-12-03","2020-12-03","2020-12-03","2020-12-29","2020-12-29","2020-12-29","2020-02-20","2020-02-20","2020-02-20","2020-12-03","2020-12-29","2020-02-20","2019-12-28","2019-12-28","2019-12-28","2020-02-20","2020-12-26","2020-12-26","2020-12-18","2020-12-26","2020-12-18","2020-12-26","2020-12-18","2020-12-18","2020-12-18","2020-12-26","2019-12-28","2019-12-28","2020-02-20"],"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":[["","31722088390","ROSUVASTATIN ","TAB 10MG","31","Select","Select",""],["","68382011714","RISPERIDONE ","TAB 4MG","31","Select","Select",""],["","23155010210","METFORMIN ","TAB 500MG","62","Select","Select",""],["","69618000901","VITAMIN ","CAP 2000UNIT","31","Select","Select",""],["","62756079813","DIVALPROEX ","TAB 500MG DR","62","Select","Select",""],["","43547035510","LISINOPRIL ","TAB 30MG","31","Select","Select",""],["","69097012615","AMLODIPINE ","TAB 2.5MG","31","Select","Select",""],["","00536082585","COUGH ","SYP 100\/5ML","473","Select","Select",""],["","00193731150","CONTOUR ","TES NEXT","50","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","10","Select","Select",""],["","68462019001","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","43598044774","NICOTINE ","DIS 14MG\/24H","30","Select","Select",""],["","62107005110","TACTINAL ","TAB 500MG","60","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","00904006116","ROBAFEN ","SYP 100\/5ML","473","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","40985027416","D3 ","2000UNIT","31","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":""}]}]}