{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TICARA   L BROWN","gend":1,"add":"398 PATRICK STREET","city":"LYNCHBURG","state":"VA","zip":"24501-1521","dob":"1989-06-15","age":"","mstatus":"","insh":10068128,"cliId":"","pno":4342000045,"cno":5408167416,"email":"","ename":"","eno":"","pphy":"KATANY, STACEY K","ppno":5405864723,"pcpadd":"1613 Oakwood St Ste 201, ","pcpcity":"Bedford","pcpstate":"VA","pcpzip":245231213,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":5408167416,"add2":"                                                            ","add3":"","madd1":"398 PATRICK STREET","madd2":"                                                            ","madd3":"","mcity":"LYNCHBURG","mstate":"VA","mzip":"24501-1521","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.0","C64.9","D57.3","D64.9","N93.8","R51","F17.200","D50.9","I10","N92.0","F41.9","M54.5","R70.0","F17.210","Z79.899","G43.909","R11.0","E55.9","Z00.00","R07.0","N83.02","N93.9","R10.9","Z79.3","D47.2","E88.09","J06.9","B30.9","R21","M89.8X8","M79.89","M25.561","M25.461","K21.9","Z71.3","D72.818","D50.8","R77.8","B34.9","M54.2","M25.511","R50.9","F31.81","N91.2","J02.9","K59.00","R10.2","D72.819","Z91.018","F33.1","R10.31","R79.9","D89.0","Z11.3","M54.12","M40.202","Z30.09","M62.838"],"date":["2020-10-27","2020-01-07","2019-04-24","2020-06-02","2019-11-15","2019-12-09","2019-11-15","2019-12-09","2020-06-29","2019-12-09","2021-02-10","2020-06-30","2020-06-29","2020-06-29","2020-06-29","2020-10-30","2020-10-30","2019-02-26","2019-02-26","2019-05-05","2019-11-15","2019-11-15","2020-02-20","2019-11-16","2020-02-05","2020-02-05","2020-02-09","2020-02-09","2020-02-09","2019-03-31","2020-02-09","2019-05-08","2019-05-08","2019-12-09","2019-12-09","2020-02-05","2020-02-05","2020-02-05","2020-02-06","2020-11-27","2020-11-24","2019-03-31","2019-09-06","2020-01-07","2020-02-09","2020-02-20","2020-02-20","2020-06-02","2020-02-09","2020-12-08","2020-01-08","2020-01-28","2020-01-07","2020-01-23","2020-11-27","2020-11-27","2020-01-23","2020-05-09"],"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":[["","50111044101","TRAZODONE ","TAB 150MG","30","Select","Select",""],["","68382002210","ATENOLOL ","TAB 25MG","30","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","30","Select","Select",""],["","71093014105","METHOCARBAM ","TAB 750MG","21","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","45","Select","Select",""],["","00093535301","PROGESTERONE ","CAP 100MG","20","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","5","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","13668001005","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","16729020301","BUSPIRONE ","TAB 15MG","90","Select","Select",""],["","58914017014","CARAFATE ","SUS 1GM\/10ML","280","Select","Select",""],["","50428027137","CVS ","TAB 27-0.8MG","30","Select","Select",""],["","63824000834","MUCINEX ","TAB 600MG ER","20","Select","Select",""],["","16571020106","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","65862022701","LAMOTRIGINE ","TAB 25MG","42","Select","Select",""],["","68382091634","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00093117410","PENICILLN ","TAB 500MG","40","Select","Select",""],["","69097084507","CYCLOBENZAPR ","TAB 5MG","30","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","10","Select","Select",""],["","69842054478","ARTHRTS ","TAB 650MG","30","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","00603158658","PROMETHAZINE ","SYP DM","150","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","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","",""],["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":""}]}]}