{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" DONALD E BRYANT","gend":0,"add":"710 SPRUCE STREET","city":"BEDFORD","state":"VA","zip":"24523-2525","dob":"1973-03-30","age":"","mstatus":"","insh":10065904,"cliId":"","pno":"5402381454, 5402381454","cno":5409151507,"email":"","ename":"","eno":"","pphy":"DEHLI, TODD H","ppno":"               ","pcpadd":"1613 Oakwood St, Ste 101","pcpcity":"Bedford","pcpstate":"VA","pcpzip":245231213,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE","aligned":"","ano":"","add2":"APARTMENT A","add3":"","madd1":"710 SPRUCE STREET","madd2":"APARTMENT A","madd3":"","mcity":"BEDFORD","mstate":"VA","mzip":"24523-2525","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E55.9","L03.90","R56.9","B00.4","B20","I69.30","R41.82","N17.9","E11.9","K22.8","I10","K11.8","Z86.14","E03.9","E43","M54.5","R26.2","G81.94","M62.81","M51.17","M47.26","D04.5","A63.0","F41.9","F32.9","Z79.01","Z79.899","Z88.3","Z88.5","F17.210","Z83.3","K91.840","K61.1","Y83.8","D62","Z79.02","Z88.8","Z82.49","Z86.010","G40.909","Z85.048","G93.89","I65.23","R47.81","C44.520","D01.3","R60.0","D64.9","M54.16","Z79.4","R31.29","R51","D68.9","E86.9","I69.354","K21.0","G47.20","Z86.73","G04.90","B00.9","M79.662","M62.50","R27.8","Z74.1","G40.009","I63.431","Z02.4","K64.9","M70.22","L76.22","T81.9XXA","Z23","I63.00","C21.0","E11.29","K62.89","C21.2","I63.9","Z01.810","C44.500","E78.5","L30.9","R06.89","R53.1","S00.86XA","L03.211","Z45.2","Z86.61","R22.32","X58.XXXA","Y93.9","K29.70","R21","E11.65","Z21","R80.9","R94.4","G31.9","M48.07","K62.82","B97.7","R40.4","B37.0","E78.00","Z79.82"],"date":["2020-02-04","2019-03-12","2019-09-23","2019-08-01","2021-05-11","2019-10-15","2019-07-24","2019-05-06","2021-03-09","2019-04-17","2020-11-01","2019-04-17","2019-04-11","2021-03-09","2019-04-17","2019-08-07","2019-08-07","2019-08-07","2019-08-07","2019-06-17","2019-06-17","2019-10-02","2019-11-05","2019-09-21","2020-02-04","2019-09-13","2020-11-01","2019-09-13","2019-09-13","2020-11-01","2019-09-13","2019-09-21","2019-09-21","2019-09-21","2019-09-23","2019-12-05","2019-09-21","2019-09-21","2019-09-21","2019-12-05","2019-09-21","2019-10-04","2019-10-04","2019-10-04","2019-12-17","2020-09-10","2020-02-04","2021-03-09","2019-07-23","2021-02-11","2019-04-06","2019-04-05","2019-04-17","2019-04-05","2019-04-05","2020-04-07","2019-04-05","2020-01-23","2019-04-19","2019-04-19","2019-04-15","2019-07-24","2019-07-24","2019-07-24","2019-06-03","2019-06-03","2019-08-02","2019-08-02","2019-08-02","2019-09-23","2019-09-21","2020-02-04","2019-10-17","2019-10-25","2021-02-11","2019-09-13","2019-10-25","2019-11-01","2019-12-05","2019-12-05","2021-03-09","2021-03-09","2019-04-05","2019-04-05","2019-07-28","2019-07-28","2019-04-19","2019-06-12","2019-07-14","2019-07-14","2019-07-14","2020-04-07","2020-11-01","2020-11-01","2020-11-01","2020-11-05","2019-04-09","2019-04-05","2019-06-17","2019-12-17","2019-12-17","2019-04-05","2019-05-06","2019-12-05","2019-12-05"],"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":[["","50428031441","CVS ","CAP 1000UNIT","30","Select","Select",""],["","61958250101","BIKTARVY ","TAB ","30","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","65862024608","LEVETIRACETA ","TAB 500MG","60","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","33342032815","TRIAMCINOLON ","CRE 0.005","60","Select","Select",""],["","10370010150","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","400","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","00574704512","BELLA\/OPIUM ","SUP 16.2-30","6","Select","Select",""],["","00169185189","NOVOFINE ","MIS 32GX6MM","100","Select","Select",""],["","00378395177","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","00121477600","MEGESTROL ","SUS 400MG\/10","600","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","70710113803","FLUCONAZOLE ","TAB 100MG","21","Select","Select",""],["","60432053716","NYSTATIN ","SUS 100000","140","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","12","Select","Select",""],["","00527260243","METOPROL ","TAB 100MG ER","30","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","00093117410","PENICILLN ","TAB 500MG","40","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","66758020201","KLOR-CON ","CAP 8MEQ","28","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","70436000203","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","00169643810","LEVEMIR ","INJ FLEXTOUC","15","Select","Select",""],["","24658031205","DOXYCYCL ","TAB 100MG","18","Select","Select",""],["","68462074635","ACYCLOVIR ","OIN 0.05","30","Select","Select",""],["","49884093547","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","00093321992","KETOCONAZOLE ","CRE 0.02","60","Select","Select",""],["","10631040701","PROCTOSOL ","CRE 0.025","56.7","Select","Select",""],["","13668013601","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","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":""}]}]}