{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" BRANDON D HUNT","gend":0,"add":"908 OLIVER HILL WAY","city":"RICHMOND","state":"VA","zip":"23219-1631","dob":"1988-11-17","age":"","mstatus":"","insh":10066483,"cliId":"","pno":"8043685697, 8043003660","cno":8043685697,"email":"","ename":"","eno":"","pphy":"COCHRAN, DONALD","ppno":"               ","pcpadd":"640 North St, ","pcpcity":"Portsmouth","pcpstate":"VA","pcpzip":237042415,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"APT 106","add3":"","madd1":"908 OLIVER HILL WAY","madd2":"APT 106","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23219-1631","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G40.89","G89.3","M79.2","K59.03","T40.2X5D","F41.9","G47.00","R56.9","R11.2","C49.9","T40.2X5A","C79.51","C79.31","Z85.831","M54.31","M54.32","R10.84","R10.9","C41.9","R11.0","F11.90","G40.909","C41.0","R19.7","F11.23","Z51.81","R41.82","K57.30","R91.8","R11.10","C76.8","M51.26","M25.511","M54.9","N52.9","S19.9XXA","M54.2","R52","M43.17","M48.061","M54.5","M85.88","F32.9","R53.81","Z91.19","K56.609","C79.9","Z51.5","R00.1","M25.519","R07.9","E86.0","Z79.899","Z88.1","Z88.8","G89.4","Z02.89","C96.5","M79.672","C80.1","Z92.21","Z92.3","Z79.891"],"date":["2019-03-28","2020-10-26","2019-10-07","2019-10-07","2019-08-30","2019-10-07","2020-10-26","2020-01-02","2020-10-26","2020-10-26","2019-10-07","2020-10-26","2020-10-26","2019-05-02","2019-06-04","2019-06-04","2020-02-26","2020-01-02","2020-01-02","2020-01-02","2019-10-07","2020-01-03","2020-01-03","2020-01-13","2020-05-06","2019-03-04","2019-03-28","2019-07-28","2019-04-14","2020-01-29","2019-04-14","2020-01-03","2020-01-03","2020-01-03","2020-10-26","2019-03-29","2019-03-29","2019-05-02","2019-06-04","2019-06-04","2019-06-04","2019-06-04","2019-07-17","2019-08-30","2019-08-05","2020-01-02","2020-01-13","2020-01-13","2019-07-28","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2020-03-12","2019-06-13","2020-02-03","2019-05-02","2019-06-13","2019-06-13","2019-06-13","2019-07-02"],"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":[["","00406853001","OXYCODONE ","TAB 30MG","240","Select","Select",""],["","00406577101","METHADONE ","TAB 10MG","180","Select","Select",""],["","51991074890","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","31722053960","LEVETIRACETA ","TAB 1000MG","90","Select","Select",""],["","00071101568","LYRICA ","CAP 100MG","60","Select","Select",""],["","00093220305","METOCLOPRAM ","TAB 10MG","90","Select","Select",""],["","00093816201","QUETIAPINE ","TAB 100MG","30","Select","Select",""],["","59762151701","CELECOXIB ","CAP 200MG","30","Select","Select",""],["","69842000003","FLUTICASONE ","SPR 50MCG","9.9","Select","Select",""],["","67877056960","DRONABINOL ","CAP 5MG","60","Select","Select",""],["","57664049983","MIRTAZAPINE ","TAB 15MG","90","Select","Select",""],["","45802075930","PROMETHAZINE ","SUP 25MG","5","Select","Select",""],["","00904615760","VITAMIN ","TAB 2000UNIT","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","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}