{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICKY   D WISE","gend":0,"add":"524 DAWNRIDGE DRIVE","city":"LYNCHBURG","state":"VA","zip":"24502-3006","dob":"1959-12-23","age":"","mstatus":"","insh":10070575,"cliId":"","pno":4349445724,"cno":"               ","email":"","ename":"","eno":"","pphy":"HAGA, DAVID S","ppno":4348468421,"pcpadd":"4262 S Amherst Hwy, ","pcpcity":"Madison Heights","pcpstate":"VA","pcpzip":245725363,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"524 DAWNRIDGE DRIVE","madd2":"                                                            ","madd3":"","mcity":"LYNCHBURG","mstate":"VA","mzip":"24502-3006","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C34.90","C80.0","C80.1","C34.92","I10","E78.2","C43.9","C79.51","M89.9","R59.1","K76.9","J98.11","R91.8","R59.9","G31.9","G93.89","Z12.5","J44.9","R93.89","G89.29","R59.0","C77.9","Z51.12","Z13.31","E66.3","Z68.26","M10.9","R22.1","Z87.891","F17.210","R07.81","C43.59","M54.5","C79.9","C34.12","M89.8X9","M47.816","C78.7","R16.1","K57.30","E04.1","D23.5","C79.89","K63.5","Z80.0","R91.1","R05","R16.0","Z85.820","M54.9","F17.200","Z51.0","C78.00","G47.00","Z79.899","Z80.1","Z08","L20.84","L29.8","C77.0","M89.59","Z12.2","M79.671","D23.62","D23.61","D23.4","L81.4","D48.5","B95.8","Z23","M51.36","M54.40"],"date":["2019-05-23","2019-05-23","2019-08-16","2020-01-02","2021-02-09","2021-02-09","2021-04-14","2021-02-05","2020-12-04","2019-01-25","2019-10-18","2019-01-25","2019-09-03","2019-10-18","2019-02-19","2019-02-19","2020-06-24","2021-02-09","2019-03-14","2021-04-14","2019-02-21","2019-06-25","2019-09-13","2020-02-24","2020-02-24","2020-02-24","2020-10-07","2019-02-21","2019-05-07","2019-03-01","2019-04-29","2020-12-04","2021-02-15","2021-03-16","2019-05-03","2019-05-03","2019-05-13","2020-06-25","2019-09-03","2019-09-03","2019-09-03","2020-06-08","2020-06-08","2019-02-21","2019-02-21","2020-06-25","2019-03-26","2019-03-26","2019-03-26","2019-03-26","2019-03-26","2019-05-07","2019-06-25","2019-05-07","2019-05-07","2019-05-07","2019-06-25","2020-02-06","2020-02-06","2019-02-21","2019-10-18","2019-01-17","2019-02-15","2019-03-11","2019-03-11","2019-03-11","2019-03-11","2019-03-11","2019-10-21","2019-10-21","2021-03-16","2021-03-16"],"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":[["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","00078068166","TAFINLAR ","CAP 75MG","120","Select","Select",""],["","59011042010","OXYCONTIN ","TAB 20MG CR","60","Select","Select",""],["","70710122501","AMITRIPTYLIN ","TAB 10MG","30","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00078066815","MEKINIST ","TAB 2MG","30","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","120","Select","Select",""],["","67877025145","TRIAMCINOLON ","CRE 0.001","454","Select","Select",""],["","65862052305","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","70710120901","ALLOPURINOL ","TAB 100MG","90","Select","Select",""],["","43598029590","PREGABALIN ","CAP 150MG","60","Select","Select",""],["","00054418425","DEXAMETHASON ","TAB 4MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","59746011306","PROCHLORPER ","TAB 5MG","30","Select","Select",""],["","00310460012","BEVESPI ","AER 9-4.8MCG","10.7","Select","Select",""],["","24208091055","ERYTHROMYCIN ","OIN OP","3.5","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","69097015907","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","00832105410","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","13107008305","LORAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","68462010630","ONDANSETRON ","TAB 8MG","30","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","70461032003","FLUCLVX ","INJ 2020-21","0.5","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","14","Select","Select",""],["","53489014605","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","66689000816","NYSTATIN ","SUS 100000","240","Select","Select",""],["","68180071160","CEFDINIR ","300MG","20","Select","Select",""],["","65162068090","PROMETHAZINE ","DM","240","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","",""],["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":""}]}]}