{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TWANNA   D HARRIS","gend":1,"add":"1421 WILLIS STREET","city":"RICHMOND","state":"VA","zip":"23224-7311","dob":"1968-03-17","age":"","mstatus":"","insh":10066515,"cliId":"","pno":8045886955,"cno":8046258430,"email":"","ename":"","eno":"","pphy":"COOK, PATRICIA","ppno":8047832505,"pcpadd":"7864 Richmond Tappahannock Hwy, ","pcpcity":"Aylett","pcpstate":"VA","pcpzip":230093056,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":8049128475,"add2":"                                                            ","add3":"","madd1":"1421 WILLIS STREET","madd2":"                                                            ","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23224-7311","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.12","J45.909","R05","R06.02","R07.9","F17.200","Z79.51","F32.9","E03.9","I50.9","F14.180","R01.1","R91.8","J43.8","I45.10","R06.00","R10.9","R18.8","J90","R10.11","Z11.59","Z20.828","I51.7","J81.1","F41.1","F31.9","Z79.899","R73.03","F17.210","I50.21","J18.9","F33.3","I42.9","F12.10","F14.10","F41.9","I27.20","Z59.0","Z79.83","R53.81","I45.2","R94.31","K76.9","R16.0","R10.13","F20.9","R45.1","F43.10","Z53.29","E66.9","Z68.34","F39","F40.240","Z80.0","R10.84","R04.2","R68.89","R60.0","B37.89","Z71.89","Z71.3","Z72.0","D25.9","N83.202","Z90.49","M25.472","L03.119","M79.89","M25.571","M25.572","G43.909","R07.89","R14.0","R12","Z20.2","F33.1","I34.0","Z76.0","Z82.49","I44.4","R11.0","R09.89","M79.671","R94.5","I36.1","F33.0","R06.4","R10.0","K59.00","U07.1","I49.1"],"date":["2021-04-01","2021-04-30","2020-12-22","2020-11-04","2020-05-11","2021-04-30","2019-12-06","2019-12-12","2020-09-23","2020-11-04","2019-12-12","2019-12-10","2019-12-20","2019-12-20","2020-11-04","2020-05-11","2020-05-11","2020-03-07","2020-03-07","2020-03-07","2020-06-18","2020-10-30","2020-11-04","2021-04-20","2020-10-06","2019-07-26","2021-04-30","2019-12-12","2020-03-07","2019-12-06","2019-12-12","2019-12-06","2019-12-06","2019-12-06","2019-12-06","2020-05-12","2019-12-09","2020-06-18","2019-12-06","2020-11-04","2020-05-11","2019-12-21","2020-03-07","2020-03-07","2020-11-04","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2020-09-23","2020-05-12","2020-05-12","2019-07-19","2019-12-20","2020-03-26","2020-05-11","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-11-04","2020-11-04","2020-11-04","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2019-12-06","2020-09-23","2020-09-23","2019-08-08","2019-12-08","2019-12-12","2019-12-12","2019-12-12","2020-11-04","2020-03-07","2020-05-11","2019-08-08","2019-12-07","2019-12-09","2019-06-24","2019-07-26","2020-03-07","2020-03-07","2020-11-02","2020-11-04"],"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":[["","00378180010","LEVOTHYROXIN ","TAB 25MCG","30","Select","Select",""],["","00185012901","BUMETANIDE ","TAB 1MG","30","Select","Select",""],["","59779014139","ACID ","TAB 10MG","60","Select","Select",""],["","00536117201","ACETAMIN ","TAB 500MG","20","Select","Select",""],["","50111091601","TORSEMIDE ","TAB 10MG","30","Select","Select",""],["","67877024901","QUETIAPINE ","TAB 50MG","30","Select","Select",""],["","69315015510","HYDROCHLOROT ","TAB 12.5MG","14","Select","Select",""],["","67877021901","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","00185067401","HYDROXYZ ","CAP 25MG","56","Select","Select",""],["","68180035202","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","50428050854","CVS ","PAK ","12","Select","Select",""],["","00378021610","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","57664037708","TRAMADOL ","TAB 50MG","10","Select","Select",""],["","00085113204","PROVENTIL ","AER HFA","6.7","Select","Select",""],["","13668001005","CITALOPRAM ","TAB 20MG","28","Select","Select",""],["","68308015215","NYSTATIN ","POW 100000","15","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","60","Select","Select",""],["","68462019255","MOMETASONE ","CRE 0.001","45","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","10","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","6.7","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":""}]}]}