{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL HEBNER","gend":0,"add":"PO BOX 2174","city":"ASHLAND","state":"VA","zip":"23005-5174","dob":"1984-03-16","age":"","mstatus":"","insh":10064320,"cliId":"","pno":8044960478,"cno":8044960478,"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":9032466914,"add2":"                                                            ","add3":"","madd1":"PO BOX 2174","madd2":"                                                            ","madd3":"","mcity":"ASHLAND","mstate":"VA","mzip":"23005-5174","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.0","Z79.899","M20.42","B36.9","J98.4","F11.23","F17.200","F14.10","F15.20","F09","B18.2","Z79.1","Z20.822","B36.8","R21","M79.672","M79.671","F17.290","Z86.19","Z87.442","Z88.0","Z76.5","Z71.1","N13.2","R10.9","R11.10","M54.5","R44.1","F32.9","F41.9","R42","R68.83","Z86.59","Z20.828","T40.1X1A","R06.00","J96.02","J96.01","G92","J69.0","E87.1","N17.9","T40.5X1A","E11.9","D72.829","F14.90","F11.90","F11.20","J96.90","J95.02","F17.210","Z51.89","M79.675","N20.0","F45.21"],"date":["2021-04-19","2021-02-06","2019-04-12","2020-07-30","2020-10-17","2020-12-11","2021-04-19","2020-12-11","2020-12-24","2021-02-06","2021-02-06","2021-02-06","2021-04-19","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2021-05-05","2021-03-24","2019-11-25","2019-11-25","2019-11-25","2019-11-25","2019-12-31","2020-10-16","2021-04-19","2020-04-04","2020-04-04","2020-04-04","2020-12-28","2020-10-17","2020-10-16","2020-10-17","2020-10-17","2020-10-16","2020-10-17","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2020-12-16","2020-10-16","2020-10-16","2020-07-27","2020-12-28","2019-01-22","2019-11-25","2021-03-24"],"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":[["","68645056354","IBUPROFEN ","TAB 800MG","15","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","15","Select","Select",""],["","59148007280","ABILIFY ","INJ 400MG","1","Select","Select",""],["","00904671960","ACETAMINOPHE ","TAB 325MG","20","Select","Select",""],["","00703701301","HALOPER ","INJ 50MG\/ML","1","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","28","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","28","Select","Select",""],["","50111056001","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","68382007901","HALOPERIDOL ","TAB 5MG","60","Select","Select",""],["","42858000101","OXYCODONE ","TAB 5MG","15","Select","Select",""],["","68382013201","TAMSULOSIN ","CAP 0.4MG","7","Select","Select",""],["","55111053401","DIVALPROEX ","TAB 500MG ER","60","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","51672208002","TERBINAFINE ","CRE 0.01","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","45802043401","CLOTRIMAZOLE ","CRE 0.01","15","Select","Select",""],["","68462039610","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","67877043105","ARIPIPRAZOLE ","TAB 5MG","30","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":""}]}]}