{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YVETTE LILES","gend":1,"add":"1401 COALTER STREET","city":"RICHMOND","state":"VA","zip":"23223-4200","dob":"1969-09-11","age":"","mstatus":"","insh":10065677,"cliId":"","pno":8043091281,"cno":8043091281,"email":"","ename":"","eno":"","pphy":"COVINGTON, DAMIAN L","ppno":8042257177,"pcpadd":"11020 HULL STREET RD, ","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":231123200,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"APT 6","add3":"","madd1":"1401 COALTER STREET","madd2":"APT 6","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23223-4200","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.31","R10.13","K59.00","R10.9","J45.909","J18.9","R68.89","R10.11","J06.9","R09.81","M54.9","I10","F32.9","F20.9","Z86.59","Z87.891","Z79.899","Z86.73","Z86.19","J20.9","J30.9","J02.9","M79.609","Z04.3","K71.9","K75.9","G47.33","R07.89","R50.9","J90","R05","F06.4","Z13.31","Z68.41","Z92.29","R79.89","R79.9","S60.551A","W45.8XXA","Z23","J44.9","F17.200","J44.1","G93.0","K21.9","E55.9","G43.019","D32.9","R20.2","F41.1","F41.9","R51","G47.00","G47.30","E66.01","Z28.21","R07.9","R06.02","M26.609","L03.90","L02.91","M54.2","L72.9","Z11.3","A60.00","Z11.4","M25.561","M19.90","R53.1","R63.4","G43.009","G47.9","R06.83","R06.81","G47.10","Z71.9","A41.9","Z20.828","R52","D32.0","G89.29","R90.89","M25.562","R65.10","R00.0","F17.210","E87.6","E78.5","M25.569","M94.0","J45.20","Z20.822","E66.9","Z71.6","B19.20","J40","R10.10","K29.90","D64.9","I11.9","E53.8","R11.0","R30.0","R35.0","R91.8","E56.9","M25.473","H91.90","Z90.710","Z01.419","H53.2","H52.03","G43.011","R93.89","F19.20"],"date":["2019-01-16","2019-02-09","2019-08-27","2019-02-09","2021-05-07","2021-01-18","2021-03-10","2019-05-10","2020-08-04","2020-03-02","2019-09-17","2021-05-10","2020-05-20","2019-09-17","2020-03-16","2019-09-20","2021-05-10","2021-05-10","2021-05-10","2019-09-20","2019-09-27","2019-12-18","2021-01-12","2020-03-16","2020-07-13","2020-07-13","2021-05-07","2020-10-26","2020-10-26","2020-10-28","2021-05-07","2021-03-10","2021-03-10","2021-03-15","2021-03-10","2021-03-10","2021-03-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2020-10-28","2019-02-27","2020-09-22","2020-07-13","2019-06-19","2020-07-13","2020-01-10","2020-07-13","2020-05-20","2020-07-13","2021-01-12","2020-08-04","2020-12-21","2020-12-21","2021-03-15","2021-03-15","2021-04-13","2021-04-13","2021-04-13","2019-01-07","2019-01-07","2020-07-15","2019-12-18","2019-12-18","2020-03-24","2021-03-15","2020-07-13","2020-07-13","2020-07-13","2020-01-10","2020-05-14","2020-04-16","2020-04-16","2021-05-07","2020-10-28","2020-10-28","2019-01-21","2019-01-21","2020-03-16","2019-05-21","2020-03-24","2020-10-26","2020-10-26","2021-03-15","2021-03-15","2020-10-26","2021-01-12","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2019-07-10","2019-05-10","2019-05-10","2019-12-18","2019-12-18","2019-12-18","2020-07-13","2020-07-15","2020-07-15","2020-10-26","2019-04-15","2019-09-20","2019-09-20","2019-11-18","2019-11-18","2020-01-14","2020-01-14","2020-04-13","2020-03-11","2019-08-27"],"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":[["","68382013814","TOPIRAMATE ","TAB 25MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","68180051703","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","00904759180","FERROUS ","TAB 325MG","60","Select","Select",""],["","00536106210","STOOL ","CAP 100MG","60","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","67877019905","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","69452014320","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","25.5","Select","Select",""],["","00378967193","IPRATROPIUM\/ ","SOL ALBUTER","90","Select","Select",""],["","00173086910","ANORO ","AER 62.5-25","60","Select","Select",""],["","00228212710","CLONIDINE ","TAB 0.1MG","60","Select","Select",""],["","00904576960","ARTHRTS ","TAB 650MG","90","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","29033000412","CARBAMAZEPIN ","CAP 300MG ER","120","Select","Select",""],["","16729017301","AMITRIPTYLIN ","TAB 50MG","30","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","40","Select","Select",""],["","00173088710","TRELEGY ","AER ELLIPTA","60","Select","Select",""],["","13668001101","CITALOPRAM ","TAB 40MG","30","Select","Select",""],["","69315012701","FOLIC ","TAB 1000MCG","30","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","3","Select","Select",""],["","65862014836","SUMATRIPTAN ","TAB 100MG","9","Select","Select",""],["","51991001406","MELATONIN ","TAB 3MG","30","Select","Select",""],["","59746017506","PREDNISONE ","TAB 20MG","2","Select","Select",""],["","00781261301","AMOXICILLIN ","CAP 500MG","12","Select","Select",""],["","00781279010","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","16729010912","QUETIAPINE ","TAB 150MG ER","30","Select","Select",""],["","00536116361","MUCUS ","TAB 600MG ER","30","Select","Select",""],["","60505258009","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","00536252525","CAPSAICIN ","CRE 0.00025","60","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","00781502207","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","00093015010","APAP\/CODEINE ","TAB 300-30MG","20","Select","Select",""],["","58657050016","CODEINE\/GG ","SOL 10-100\/5","240","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00172572860","FAMOTIDINE ","TAB 20MG","20","Select","Select",""],["","00904671980","ACETAMINOPHEN ","TA B 325","100","Select","Select",""],["","50111056001","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","00069046903","CHANTIX ","PAK 1MG","56","Select","Select",""],["","68462019001","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","69315090505","LORAZEPAM ","TAB 1MG","4","Select","Select",""],["","69618001001","ACETAMIN ","TAB 325MG","20","Select","Select",""],["","60258015001","SF ","CRE 0.011","51","Select","Select",""],["","55111061901","ESZOPICLONE ","TAB 2MG","30","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","10","Select","Select",""],["","00781571001","POT  CL MICRO","TAB 10MEQ ER","30","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","67877021901","CEPHALEXIN ","CAP 500MG","15","Select","Select",""],["","00245531811","KLOR-CON ","TAB 15MEQ ER","7","Select","Select",""],["","68180071160","CEFDINIR ","300MG","14","Select","Select",""],["","10702000601","CYCLOBENZAPR ","5MG","60","Select","Select",""],["","65162052110","PROMETHAZINE ","25MG","40","Select","Select",""],["","47781023001","OXYCOD\/APAP ","10-325MG","10","Select","Select",""],["","00904759080","FEROSUL ","325MG","60","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":""}]}]}