{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" JANICE C LESTER","gend":1,"add":"805 EDMONDS STREET","city":"DANVILLE","state":"VA","zip":"24541-4417","dob":"1957-04-23","age":"","mstatus":"","insh":10065722,"cliId":"","pno":"4347103230, 4347103230","cno":4347928312,"email":"","ename":"","eno":"","pphy":"WINFIELD II, ALBERT C","ppno":"               ","pcpadd":"441 Piney Forest Rd, Ste E","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":245404154,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"WESTERN","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"805 EDMONDS STREET","madd2":"                                                            ","madd3":"","mcity":"DANVILLE","mstate":"VA","mzip":"24541-4417","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.02","Z46.82","J96.90","J43.9","J96.01","J44.1","M79.89","R09.89","J44.9","F41.9","Z99.81","R53.1","Z13.89","Z79.899","G89.4","J96.12","M17.0","M96.1","M16.0","M54.17","F11.20","A41.9","J10.08","R65.21","J15.9","J96.02","J44.0","K86.1","R62.7","F17.210","G89.29","I10","F41.1","R09.02","J96.21","J09.X1","F41.0","Z79.891","R06.89","R64","R94.2","I27.9","I27.21","Z98.890","Z85.44","I27.81","Z87.891","J43.1","R10.9","K86.89","K21.9","E78.00","Z88.0","Z88.8","Z88.6","D72.829","J96.22","D53.9","F32.9","G54.2","Z90.710","Z72.0","E78.2","R06.09","R94.31","Z88.5","R13.12","R06.03","Z23","E78.5","R07.89","R69","S01.311A","H60.8X3"],"date":["2021-04-07","2019-02-18","2019-02-24","2019-02-18","2019-04-01","2019-05-07","2019-02-26","2019-02-28","2021-04-07","2019-03-14","2019-09-25","2019-03-14","2019-09-25","2021-05-03","2021-05-03","2020-01-04","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2020-08-11","2019-03-08","2019-02-18","2019-03-08","2019-02-18","2019-03-02","2019-02-18","2019-02-18","2019-02-18","2019-02-18","2019-02-25","2020-09-23","2019-02-18","2021-04-07","2019-05-05","2019-03-11","2019-03-11","2021-02-23","2021-04-07","2021-04-07","2021-04-07","2021-04-07","2019-07-16","2019-07-16","2019-07-16","2019-07-16","2019-07-16","2021-04-07","2019-03-02","2019-02-18","2019-09-25","2019-02-18","2019-05-04","2019-05-04","2019-02-18","2019-05-05","2019-05-05","2019-05-05","2019-05-05","2019-05-05","2019-05-05","2019-05-04","2020-09-23","2020-09-23","2020-09-23","2019-05-04","2019-03-02","2019-02-18","2020-11-18","2020-09-23","2019-02-13","2019-05-07","2020-02-26","2020-02-26"],"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":[["","33342002208","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","45","Select","Select",""],["","00781723864","BUPREN\/NALOX ","MIS 8-2MG","45","Select","Select",""],["","49502080632","YUPELRI ","SOL ","90","Select","Select",""],["","67877019810","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","00591544205","PREDNISONE ","TAB 10MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","65862064169","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","68382066101","SPIRONOLACT ","TAB 50MG","30","Select","Select",""],["","13668048450","MINOCYCLINE ","CAP 100MG","40","Select","Select",""],["","63824000834","MUCINEX ","TAB 600MG ER","60","Select","Select",""],["","16103036907","CALCIUM ","TAB VIT D","30","Select","Select",""],["","16729017001","ESCITALOPRAM ","TAB 20MG","30","Select","Select",""],["","67405067196","HYDROXYZ ","TAB 25MG","90","Select","Select",""],["","45802011859","MOMETASONE ","SOL 0.001","30","Select","Select",""],["","11917019262","MUCUS ","TAB 600MG ER","60","Select","Select",""],["","00487020101","IPRATROPIUM\/ ","SOL ALBUTER","180","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","00781540092","ROSUVASTATIN ","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":[[["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":""}]}]}