{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LENORA HOLDER","gend":1,"add":"9805 LAURANDREW COURT","city":"HENRICO","state":"VA","zip":"23228-1234","dob":"1943-12-09","age":"","mstatus":"","insh":10067180,"cliId":"","pno":8046879477,"cno":8049221591,"email":"","ename":"","eno":"","pphy":"VCU CENTER FOR ADVANCED HEALTH","ppno":8042543500,"pcpadd":"MCV Physicians, 2116 W Laburnum Ave Ste 100","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232274359,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":8049221591,"add2":"                                                            ","add3":"","madd1":"9805 LAURANDREW COURT","madd2":"                                                            ","madd3":"","mcity":"HENRICO","mstate":"VA","mzip":"23228-1234","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","R00.1","N18.6","I10","T82.868A","E87.5","E83.41","D50.9","N25.81","Z99.2","D63.1","S31.109D","R99","T82.898A","I12.0","E11.22","F03.90","F32.9","Z79.899","I70.219","R32","R15.9","I95.9","I73.9","G93.40","R76.8","N30.91","E83.52","I44.1","E21.2","Z86.73","R41.82","A53.0","E11.649","Z20.828","I44.0","I21.19","T82.858A","I87.1","E78.5","R53.1","Z23","R15.2","I70.203","E11.9","Z78.9","I25.2","R94.31","I16.0","G93.41","I16.1","H57.02","R13.10","Z01.818","A53.9","G04.30","Z87.440","B35.1","K59.00","E11.51","E03.9","E66.9","Z79.52","G93.89","G23.8","M89.9","Z68.30","Z91.81","G93.49","Z79.4","I63.9","T82.838A","Z79.82","E44.0","D35.1","I12.9","N18.9","N39.498","R09.89","L03.115","S71.101D","S71.101S","R19.7","Z13.0","Q66.89","L84","E21.0","J69.0","E11.65","Z49.01","S71.109A","S71.101A","M20.12","M20.11","L60.2","I51.7","N30.90","R06.00","R91.8","J98.6","E21.3","B34.9","T82.848A","I77.1","I49.9","H35.033","I45.9","R05"],"date":["2021-02-26","2020-09-22","2021-05-20","2020-09-22","2020-11-16","2020-03-10","2019-06-03","2020-03-02","2021-04-02","2021-05-20","2021-04-02","2019-10-02","2020-03-16","2021-05-20","2021-05-20","2021-05-20","2020-10-22","2020-08-17","2020-10-22","2020-03-12","2021-04-30","2021-04-30","2020-07-30","2020-09-08","2020-11-03","2020-08-06","2020-08-05","2020-11-03","2020-08-14","2020-09-09","2020-11-03","2020-08-18","2020-11-03","2020-08-18","2020-08-31","2020-11-13","2020-11-13","2021-05-20","2021-05-20","2021-05-20","2019-07-15","2020-10-02","2019-12-12","2020-03-19","2020-09-22","2020-04-22","2020-08-07","2020-08-07","2020-08-03","2020-08-02","2020-08-02","2020-08-02","2020-08-03","2020-08-09","2020-08-17","2020-09-09","2020-11-03","2020-11-17","2020-10-22","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2020-08-02","2020-08-02","2020-08-07","2020-08-20","2020-08-20","2020-09-22","2020-09-22","2020-09-22","2019-06-03","2019-07-15","2020-08-01","2020-08-01","2019-09-03","2019-09-03","2019-09-03","2019-06-03","2019-07-28","2019-07-29","2019-07-29","2019-12-12","2020-08-03","2020-02-25","2020-11-17","2020-08-04","2020-11-13","2020-11-17","2019-06-03","2019-07-31","2019-10-10","2019-09-17","2019-09-17","2019-09-17","2020-11-13","2020-08-15","2020-11-13","2020-11-13","2020-11-13","2020-11-16","2020-11-16","2021-05-20","2021-05-20","2019-06-03","2019-09-13","2020-08-04","2020-11-13"],"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":[["","31722070210","LOSARTAN ","TAB 100MG","30","Select","Select",""],["","55513007330","SENSIPAR ","TAB 30MG","90","Select","Select",""],["","68462044718","SEVELAMER ","TAB 800MG","180","Select","Select",""],["","68682010710","NIFEDIPINE ","TAB 90MG ER","30","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","68645051654","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","45802086866","POLYETH ","POW 3350 NF","7","Select","Select",""],["","55111015330","ONDANSETRON ","TAB 4MG","28","Select","Select",""],["","49884000901","ISOSORB ","TAB 30MG","90","Select","Select",""],["","00093715310","SIMVASTATIN ","TAB 10MG","30","Select","Select",""],["","50111039701","HYDRALAZINE ","TAB 100MG","90","Select","Select",""],["","99073070914","FREESTYLE    KIT FREEDOM","KIT FREEDOM","1","Select","Select",""],["","43547027511","DONEPEZIL ","TAB 5MG","30","Select","Select",""],["","16729044110","CINACALCET ","TAB 60MG","30","Select","Select",""],["","58468002101","RENAGEL ","TAB 800MG","180","Select","Select",""],["","67405065105","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","60793070210","BICILLIN ","INJ 2400000","8","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","20","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":""}]}]}