{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARK   B HAMLIN","gend":0,"add":"601 BRIDGE STREET","city":"DANVILLE","state":"VA","zip":"24541-1459","dob":"1955-04-15","age":"","mstatus":"","insh":10065383,"cliId":"","pno":4346886845,"cno":4346886845,"email":"","ename":"","eno":"","pphy":"TRIVEDI, RAJENDRA S","ppno":4347923730,"pcpadd":"501 Rison St, Ste 120","pcpcity":"Danville","pcpstate":"VA","pcpzip":245412426,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":3017423308,"add2":"APARTMENT 212","add3":"","madd1":"601 BRIDGE STREET","madd2":"APARTMENT 212","madd3":"","mcity":"DANVILLE","mstate":"VA","mzip":"24541-1459","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.5","I10","R94.5","Z79.899","R53.82","F17.210","M79.651","M62.81","I50.21","R06.02","Y92.230","J96.01","E87.1","I48.1","I42.0","I51.3","R53.1","E87.5","E83.41","E87.6","D72.829","I25.10","I95.2","I27.20","I50.9","R26.89","J44.9","Z02.6","R60.9","F25.9","I48.0","R06.00","R41.82","Z12.5","I42.6","L59.0","Z79.01","S76.111A","G47.00","I50.82","R57.0","I25.9","Z13.29","N39.0","I50.20","F10.20","K70.9","I50.42","L57.0","E03.9","M10.9","F20.9","E87.8","F10.99","Z13.1","R74.8","I50.41","I95.9","R11.0","J44.1","G45.9","I48.91","R06.2"],"date":["2020-09-22","2020-09-22","2019-04-09","2021-03-11","2021-02-16","2020-04-16","2019-07-01","2019-07-01","2019-07-19","2021-03-11","2019-07-15","2019-07-19","2019-07-21","2019-07-19","2021-03-18","2021-03-18","2019-07-19","2019-07-21","2019-07-19","2019-07-15","2019-07-15","2019-07-15","2019-07-15","2019-07-15","2021-02-16","2019-07-01","2021-02-16","2019-07-15","2019-09-03","2020-01-16","2021-03-18","2019-09-03","2019-07-15","2019-09-03","2021-02-16","2020-01-16","2021-03-18","2019-06-28","2019-06-28","2019-08-06","2019-07-21","2019-07-23","2021-02-16","2020-09-22","2021-03-18","2020-09-17","2021-03-18","2020-09-22","2019-08-13","2020-09-22","2020-09-22","2021-03-18","2019-08-08","2020-05-20","2021-02-16","2021-03-02","2019-07-23","2019-07-23","2019-07-11","2019-07-11","2019-07-16","2019-07-16","2019-10-14"],"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":[["","00904053980","THERA ","TAB ","30","Select","Select",""],["","55111046705","METOPROL ","TAB 50MG ER","30","Select","Select",""],["","16729004417","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","58657015010","FOLIC ","TAB 1MG","30","Select","Select",""],["","00078065920","ENTRESTO ","TAB 24-26MG","60","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","00527132510","DIGOX ","TAB 0.25MG","30","Select","Select",""],["","64980029101","PERPHENAZINE ","TAB 4MG","120","Select","Select",""],["","49035053206","EQ ","GUM 4MG MINT","160","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","00143124101","DIGOXIN ","TAB 0.25MG","30","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","69315011710","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","59762330403","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","10135013210","THIAMINE ","TAB 100MG","30","Select","Select",""],["","00115180301","HYDROXYZ ","CAP 25MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","00591544205","PREDNISONE ","TAB 10MG","20","Select","Select",""],["","00487020160","IPRATROPIUM\/ ","SOL ALBUTER","360","Select","Select",""],["","45963067696","METOPROLOL ","50MG ER","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}