{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMY TARABAY","gend":1,"add":"AMY TARABAY                                                 ","city":"RICHMOND                      ","state":"VA","zip":"23225-4128","dob":"1999-10-05","age":"","mstatus":"","insh":10100346,"cliId":"","pno":8048061916,"cno":8048061916,"email":"","ename":"","eno":"","pphy":"KUSHINKA, JEFFREY T                                         ","ppno":"","pcpadd":"1001 E Marshall St Fl 3","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232985075,"pcpcounty":"","pcpid":"P9058514","pcpname":"THE CHILDRENS PAVILION OF VCUHS","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"1451 SPRING GROVE DRIVE                                     ","add3":"","madd1":"AMY TARABAY                                                 ","madd2":"1451 SPRING GROVE DRIVE                                     ","madd3":"","mcity":"RICHMOND                      ","mstate":"VA","mzip":"23225-4128","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.81","F41.1","F43.10","R00.0","R51","T44.6X2A","T43.592A","F33.1","R11.2","R45.851","Y92.89","F33.9","I95.9","F41.9","T42.6X2A","F60.3","Z79.899","Z79.2","Z79.82","Z88.1","Z88.5","Z88.8","F39","G47.00","I10","F17.210","T74.31XA","Z82.49","F32.9","Z01.419","Z11.3","Z30.431","N89.8","N76.0","Z00.00","F31.9","R10.2","Z30.432","Z30.09","L03.116","E55.9","Z68.24","F33.2","R68.89","E78.2","N91.2","F34.89","J06.9","R10.9","Z20.828","F33.3","F14.20","M54.2","Y09","Y93.89","Z04.71","Y07.03","Y04.2XXA","S09.90XA","M79.641","L25.9","F31.4","K52.9","N94.4","N30.00","M25.571","L03.90","F14.10","R11.0","F31.32","F31.30","F90.2","T46.6X5A","T43.505A","F10.129","J96.01","T46.5X1A","G92","T42.4X2A","Y90.1","Z20.822","R57.8","J69.0","F17.200","I95.2","E87.6","Z04.9","Z93.0","T50.902A","T50.904A","J96.90","J98.4","F10.20","G93.41","F12.10","F31.89","J40","Z72.0"],"date":["2021-05-27","2021-11-21","2021-05-29","2020-06-20","2019-04-05","2019-04-07","2021-05-24","2021-07-02","2021-04-14","2019-04-08","2020-06-20","2019-04-06","2021-05-22","2019-06-14","2019-04-06","2021-05-22","2019-04-06","2019-04-06","2019-04-06","2019-04-06","2019-04-06","2019-04-06","2019-04-10","2021-05-22","2021-05-22","2020-06-20","2019-04-07","2019-04-07","2019-06-14","2019-06-07","2019-06-07","2019-07-18","2019-06-07","2019-06-07","2019-06-14","2021-05-22","2019-07-18","2019-08-02","2020-02-18","2019-09-02","2020-04-14","2019-11-26","2020-04-19","2019-12-20","2020-01-14","2020-04-14","2020-03-18","2020-02-15","2020-02-18","2021-10-12","2020-06-23","2021-06-02","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-07-01","2021-11-21","2020-09-04","2020-09-26","2020-09-26","2020-09-28","2020-09-28","2021-05-27","2020-11-09","2021-01-31","2021-02-09","2021-02-09","2021-05-22","2021-05-22","2021-05-22","2021-05-28","2021-05-22","2021-05-24","2021-05-22","2021-05-22","2021-05-22","2021-05-22","2021-05-28","2021-05-27","2021-05-22","2021-05-28","2021-05-28","2021-05-23","2021-05-24","2021-05-27","2021-05-27","2021-05-23","2021-05-24","2021-05-28","2021-05-27","2021-06-02","2021-10-12","2021-10-12"],"priorHcc":["",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","63402030430","LATUDA","40MG","30","Select","Select",""],["","65862050320","AMOX\/K","875-125","6","Select","Select",""],["","43547034006","RISPERIDONE","0.5MG","30","Select","Select",""],["","50111056001","TRAZODONE","50MG","30","Select","Select",""],["","42806016105","HYDROXYZ","50MG","30","Select","Select",""],["","00536589688","NICOTINE","21MG\/24H","30","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","65862066130","ARIPIPRAZOLE","2MG","90","Select","Select",""],["","69097012203","TOPIRAMATE","25MG","63","Select","Select",""],["","65862022701","LAMOTRIGINE","25MG","42","Select","Select",""],["","61874011530","VRAYLAR","1.5MG","30","Select","Select",""],["","33342006807","OLANZAPINE","5MG","30","Select","Select",""],["","70436001002","BUPROPN","150MG XL","30","Select","Select",""],["","00228212750","CLONIDINE","0.1MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","00052433001","NEXPLANON","68MG","1","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","20","Select","Select",""],["","49483060450","IBUPROFEN","800MG","30","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","21","Select","Select",""],["","69315012710","FOLIC","1000MCG","30","Select","Select",""],["","00536354710","DAILY-VITE","","30","Select","Select",""],["","68180016113","AZITHROMYCIN","500MG","5","Select","Select",""],["","10006070011","VITAMIN","100MG","30","Select","Select",""],["","63402030430","LATUDA ","TAB 40MG","30","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","6","Select","Select",""],["","43547034006","RISPERIDONE ","TAB 0.5MG","30","Select","Select",""],["","50111056001","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","42806016105","HYDROXYZ ","TAB 50MG","30","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","30","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","65862066130","ARIPIPRAZOLE ","TAB 2MG","90","Select","Select",""],["","69097012203","TOPIRAMATE ","TAB 25MG","63","Select","Select",""],["","65862022701","LAMOTRIGINE ","TAB 25MG","42","Select","Select",""],["","61874011530","VRAYLAR ","CAP 1.5MG","30","Select","Select",""],["","33342006807","OLANZAPINE ","TAB 5MG","30","Select","Select",""],["","70436001002","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","00228212750","CLONIDINE ","TAB 0.1MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","00052433001","NEXPLANON ","IMP 68MG","1","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","21","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","30","Select","Select",""],["","00536354710","DAILY-VITE ","TAB ","30","Select","Select",""],["","68180016113","AZITHROMYCIN ","TAB 500MG","5","Select","Select",""],["","10006070011","VITAMIN ","TAB 100MG","30","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","",""],["N\/A","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":""}]}]}