{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" GWENDOLYN PERRY","gend":1,"add":"216 NEWBRIDGE CIRCLE","city":"RICHMOND","state":"VA","zip":"23223-6273","dob":"1960-06-29","age":"","mstatus":"","insh":10065667,"cliId":"","pno":"8047144764, 8044059046","cno":8047144764,"email":"","ename":"","eno":"","pphy":"POPOVICH, STEPHEN J","ppno":"               ","pcpadd":"8000 Brook Rd, ","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232271306,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"APT F","add3":"","madd1":"216 NEWBRIDGE CIRCLE","madd2":"APT F","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23223-6273","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","I25.10","Z87.898","Z91.19","J18.9","J44.1","J96.21","R68.89","F33.3","I50.9","I47.2","I47.1","I50.23","Z68.42","J96.10","Z99.81","J44.9","I11.0","E87.6","E83.42","E66.01","E11.22","N18.2","E27.8","R73.9","E11.8","F32.9","I25.2","I50.22","Z95.810","Z79.82","Z79.4","I51.7","I36.1","E11.9","R41.82","J96.02","E87.70","T40.5X1A","G92","Z68.41","E66.2","I13.0","I25.5","Z96.1","I27.20","E78.00","N28.9","G93.40","I10","E11.69","E66.9","J96.12","Z86.74","Z86.2","K21.9","J96.11","I08.1","I44.5","I49.9","I45.10","D72.819","D72.810","D69.6","D75.1","I27.9","Z87.891","Z86.59","E86.0","I95.9","E78.5","D50.9","N19","R07.9","R06.00","N28.89","N28.1","E27.9","I49.1","T82.190A","I48.91","I50.33","I49.8","R94.31","I21.4","F14.10","R53.1","I21.A1","J96.22","I50.43","N17.9","E11.649","I45.9","I45.89","E11.40","N18.9","Z68.43","E87.3","Z53.29","Z20.822","N18.30","R79.89","R91.8","I50.82","J98.4","R06.02","R05","R09.89","J81.0","T82.198D","K76.89","R74.0","R09.02","Z71.89","Z71.3","I50.21","Z45.02","I50.20","Z72.0","Z23","I50.42","E11.59","Z95.5","J96.01","Z79.02","N18.4","F14.90","G47.33","N18.3","D64.9","I70.0","D35.00","R60.0","R60.9","F43.21","Z79.899","J81.1","R19.7","I50.32","J44.0","F17.210","Z20.828","E11.29","Z28.83","R94.5","I50.31","R74.8","R19.00","Z59.0","E87.5","N18.31","I12.9","R31.9","G47.30","I50.30","I50.40","R22.33","R22.43","I21.19","K76.9","D69.59","M79.605","R33.9","I87.8","I31.3","J96.90","I50.810"],"date":["2020-11-05","2021-03-17","2019-02-28","2019-02-28","2019-03-20","2019-11-27","2021-03-22","2020-06-09","2021-05-15","2021-03-17","2019-06-11","2020-06-04","2020-10-09","2021-03-17","2021-01-08","2020-12-21","2021-04-01","2021-03-17","2019-06-12","2019-06-12","2021-03-17","2021-05-17","2020-06-06","2019-06-12","2019-06-16","2019-12-04","2021-03-02","2020-11-04","2021-03-12","2021-03-12","2019-12-26","2021-05-17","2021-03-04","2020-12-28","2021-03-12","2020-03-03","2020-03-03","2021-03-17","2020-03-03","2020-03-03","2020-06-04","2020-03-03","2021-03-22","2020-10-09","2020-03-03","2021-03-22","2021-03-02","2021-03-02","2020-03-09","2020-10-19","2020-03-09","2020-03-09","2020-12-21","2020-11-17","2020-10-18","2021-03-08","2021-03-04","2020-10-16","2021-03-17","2020-10-16","2021-03-02","2021-03-12","2021-01-08","2021-03-17","2021-03-22","2021-01-08","2021-01-08","2021-01-08","2021-03-12","2021-03-12","2021-03-22","2021-03-12","2021-03-17","2021-03-17","2021-03-17","2021-03-22","2021-03-22","2021-03-22","2020-06-04","2019-11-26","2020-06-06","2020-12-21","2021-03-02","2020-03-03","2020-06-04","2020-06-08","2020-06-04","2020-06-06","2021-03-17","2021-03-22","2021-03-22","2021-03-06","2020-06-04","2021-03-02","2020-11-16","2021-05-17","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-03-22","2021-03-06","2021-03-17","2021-03-22","2019-03-18","2020-12-21","2021-03-17","2019-06-11","2019-06-11","2019-06-16","2019-06-24","2019-06-16","2020-12-21","2020-01-02","2020-01-02","2019-11-27","2019-11-28","2020-11-04","2019-06-24","2021-04-16","2020-11-17","2020-09-18","2020-12-29","2020-03-04","2020-06-06","2020-06-06","2020-06-06","2021-03-17","2020-06-07","2020-06-24","2020-12-21","2021-01-25","2021-03-02","2021-03-02","2019-09-26","2020-09-04","2020-10-09","2020-06-04","2019-03-18","2019-03-18","2019-11-27","2021-03-17","2021-04-01","2021-02-04","2021-03-07","2021-03-08","2021-03-08","2021-03-08","2021-04-01","2020-10-09","2020-10-09","2021-03-06","2021-03-21","2019-11-27","2020-03-03","2020-06-19","2020-12-21","2020-12-21","2021-03-02","2021-03-17","2021-03-17","2021-03-17","2021-03-22","2020-03-06","2020-03-06","2020-03-06","2021-03-04"],"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":[["","65862019301","FLUOXETINE ","CAP 20MG","30","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","200","Select","Select",""],["","00193709021","CONTOUR ","TES BLD GLUC","100","Select","Select",""],["","43547035610","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","13668010401","ISOSORB ","TAB 30MG ER","30","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","15","Select","Select",""],["","50111091703","TORSEMIDE ","TAB 20MG","120","Select","Select",""],["","00054430125","FUROSEMIDE ","TAB 80MG","60","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","65862073205","AMIODARONE ","TAB 200MG","30","Select","Select",""],["","62332010030","ARIPIPRAZOLE ","TAB 15MG","30","Select","Select",""],["","00002822259","INSULIN ","INJ 100\/ML","15","Select","Select",""],["","00169406013","VICTOZA ","INJ 18MG\/3ML","9","Select","Select",""],["","50742061510","METOPROL ","TAB 25MG ER","30","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","30","Select","Select",""],["","60505464303","PRASUGREL ","TAB 10MG","30","Select","Select",""],["","49483048110","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","10006070022","VITAMIN ","TAB 1000MCG","30","Select","Select",""],["","60505267108","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","00002751001","HUMALOG ","INJ 100\/ML","10","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","67877019910","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","11822316910","RA ","TAB 81MG EC","30","Select","Select",""],["","76204020025","ALBUTEROL ","NEB 0.00083","300","Select","Select",""],["","59746021601","SPIRONOLACT ","TAB 25MG","60","Select","Select",""],["","08222710031","PEN  NEEDLES  ","MIS 32GX4MM","100","Select","Select",""],["","00002771559","BASAGLAR ","INJ 100UNIT","15","Select","Select",""],["","68462063945","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","70436001004","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","68180065208","DOXYCYC ","CAP 100MG","10","Select","Select",""],["","00143973810","PREDNISONE ","TAB 20MG","5","Select","Select",""],["","57599080000","FREESTY ","KIT 2 SENSOR","2","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":""}]}]}