{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" DANNY  MITCHELL","gend":0,"add":"4533 MOUNT CROSS RD #LOT #8","city":"DANVILLE","state":"VA","zip":"24540-5375","dob":"1974-09-09","age":"","mstatus":"","insh":10101691,"cliId":"","pno":"4348220370, 4348220370","cno":4347096282,"email":"","ename":"","eno":"","pphy":"UNKNOWN PROVIDER QNXT PCP","ppno":"               ","pcpadd":"UNKNOWN STREET, ","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":232190000,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"WESTERN","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"4533 MOUNT CROSS RD #LOT #8","madd2":"                                                            ","madd3":"","mcity":"DANVILLE","mstate":"VA","mzip":"24540-5375","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","M54.40","G47.33","J44.9","N18.2","N20.2","D64.9","Z79.899","R73.03","E78.5","E03.9","E55.9","Z91.81","R06.02","Z72.0","R09.02","K76.0","M45.5","G47.09","F60.9","G47.30","K59.00","F32.9","F39","N40.0","M25.552","M25.551","J45.909","R94.5","S50.851A","N20.1","N20.0","R79.89","Z99.11","M51.36","J30.9","R52","M54.9","M62.81","R26.89","M79.604","R31.0","G47.00"],"date":["2021-01-04","2020-04-13","2021-01-14","2021-04-07","2019-08-26","2019-08-26","2021-04-07","2020-03-27","2021-04-07","2021-04-07","2021-04-07","2021-04-07","2019-04-25","2020-12-10","2020-12-10","2019-11-20","2021-04-07","2020-03-27","2021-04-07","2021-04-07","2021-01-04","2020-10-01","2021-04-07","2020-07-01","2021-01-04","2019-09-27","2019-09-27","2020-05-26","2021-01-04","2020-10-01","2021-04-05","2021-04-12","2019-08-26","2020-10-01","2021-01-04","2020-12-10","2019-03-27","2019-03-29","2019-12-27","2021-04-07","2021-04-07","2021-04-05","2019-01-17"],"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":[["","70954002010","PRAZOSIN ","CAP 2MG","30","Select","Select",""],["","16729014917","QUETIAPINE ","TAB 300MG","60","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","16729004716","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","63868000230","NATURA-LAX ","POW 3350 NF","510","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","00781518110","LEVOTHYROXIN ","TAB 50MCG","30","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","59746017310","PREDNISONE ","TAB 10MG","10","Select","Select",""],["","00378827091","ALBUTEROL ","NEB 0.00083","300","Select","Select",""],["","00071101668","LYRICA ","CAP 150MG","60","Select","Select",""],["","68462035901","NABUMETONE ","TAB 750MG","20","Select","Select",""],["","51991074710","DULOXETINE ","CAP 30MG","45","Select","Select",""],["","13668001005","CITALOPRAM ","TAB 20MG","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","",""],["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":""}]}]}