{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RANEAL O'MALEY","gend":0,"add":"11400 RAILROAD LANE","city":"LOCUST GROVE","state":"VA","zip":"22508-3043","dob":"1962-04-02","age":"","mstatus":"","insh":10070838,"cliId":"","pno":5409727238,"cno":5409727238,"email":"","ename":"","eno":"","pphy":"GRAY, DANIEL P","ppno":5408345440,"pcpadd":"12101 Carol Ln, ","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224076101,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APARTMENT 2","add3":"","madd1":"11400 RAILROAD LANE","madd2":"APARTMENT 2","madd3":"","mcity":"LOCUST GROVE","mstate":"VA","mzip":"22508-3043","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N50.82","N45.1","I10","E11.65","E78.5","M1A.9XX0","C61","Z01.818","E11.621","L97.529","M86.171","Z85.46","E11.9","E66.9","Z68.34","Z79.4","M19.90","G89.29","M54.9","Z79.84","Z79.891","Z87.891","Z88.0","L03.115","Z98.890","E11.628","L03.032","L02.612","F11.20","R39.81","N42.9","M14.672","E11.40","L97.512","S90.822A","L03.90","M86.172","L03.116","Z45.2","M86.9","T81.41XA","E11.42","R97.20","N30.00","N49.2","E11.3293","H25.813","R74.8","R93.89","K76.0","E78.2","E11.69","B95.1","L97.528","J44.9","N45.4","Z68.30","R25.2","R94.5","L02.214","L72.9","Z90.79","Z82.49","Z80.1","Z80.42","Z68.33","N50.9","M54.5","L97.522","M86.272","L97.521","A52.16","R16.0","Z90.49","Z79.899","A41.9","Z68.29","G89.4","E87.5","Z91.19","L08.9","A49.9","E87.1","N17.9","R32","N50.89","I96","Z23","E86.0","L02.212","N50.1","M25.375","N45.3","D64.9","B96.20","Z16.24","G62.9","J86.9","M86.279"],"date":["2019-01-16","2019-01-20","2021-05-19","2020-10-02","2020-10-02","2019-05-03","2020-10-14","2019-03-01","2020-04-20","2020-04-27","2019-04-04","2020-10-02","2020-10-02","2020-10-02","2019-03-22","2020-10-02","2019-03-27","2019-11-25","2020-10-02","2019-11-25","2019-03-27","2020-10-02","2020-03-13","2019-04-04","2019-04-04","2019-08-21","2020-06-12","2020-04-20","2021-05-04","2021-05-01","2021-05-01","2020-10-30","2020-06-26","2019-12-06","2019-12-06","2020-02-14","2020-06-12","2020-04-22","2020-04-20","2020-03-30","2020-04-20","2021-05-19","2019-01-08","2019-01-17","2021-04-20","2019-10-08","2019-10-08","2020-01-02","2020-01-02","2020-02-14","2021-05-19","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2020-10-02","2020-10-02","2019-07-24","2019-12-18","2020-09-25","2020-09-25","2020-10-02","2020-10-02","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2021-05-19","2020-05-11","2019-01-03","2019-01-03","2019-10-21","2019-12-18","2020-03-11","2020-03-11","2020-03-13","2020-03-13","2020-10-02","2020-03-13","2020-10-02","2020-03-17","2020-03-17","2020-10-02","2020-10-02","2020-10-02","2020-10-02","2019-03-22","2019-11-14","2019-01-17","2021-01-05","2020-10-02","2020-10-30","2019-01-17","2019-01-17","2019-01-17","2019-01-17","2019-07-24","2019-11-25","2020-08-26"],"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":[["","00169643810","LEVEMIR ","INJ FLEXTOUC","15","Select","Select",""],["","70377000911","ROSUVASTATIN ","TAB 40MG","30","Select","Select",""],["","00254200801","COLCHICINE ","TAB 0.6MG","30","Select","Select",""],["","68382075810","METFORMIN ","TAB 500MG","120","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","180","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","45","Select","Select",""],["","00093834410","GLYBURIDE ","TAB 5MG","60","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","15","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","10702005601","OXYCODONE ","TAB 10MG","28","Select","Select",""],["","68382031818","MINOCYCLINE ","CAP 100MG","60","Select","Select",""],["","69238115409","EZETIMIBE ","TAB 10MG","90","Select","Select",""],["","50428381418","CVS ","CAP 1000MG","60","Select","Select",""],["","50428029742","FISH ","CAP 1000MG","180","Select","Select",""],["","00054457025","METHADONE ","TAB 5MG","45","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","15","Select","Select",""],["","54629001893","OMEGA-3 ","CAP 1000MG","60","Select","Select",""],["","08290328418","INSULIN ","MIS 1ML\/31G","200","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","15","Select","Select",""],["","49884093547","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","120","Select","Select",""],["","11845014638","SUPER ","CAP -3","60","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","65862009620","CEFPODOXIME ","TAB 200MG","36","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","00006011231","JANUVIA ","TAB 50MG","30","Select","Select",""],["","68180065208","DOXYCYC ","CAP 100MG","18","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","1","Select","Select",""],["","10006073038","MAG ","TAB 400MG","60","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":""}]}]}