{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CORBAN   N HODNETT","gend":1,"add":"1106 ARDMORE DRIVE","city":"LYNCHBURG","state":"VA","zip":"24501-2205","dob":"1990-07-18","age":"","mstatus":"","insh":10120931,"cliId":"","pno":4349429584,"cno":4349429584,"email":"","ename":"","eno":"","pphy":"HAUPRICHT, BRADLEY J","ppno":4345822273,"pcpadd":"1971 University Blvd, ","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245150002,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"APT 9","add3":"","madd1":"1106 ARDMORE DRIVE","madd2":"APT 9","madd3":"","mcity":"LYNCHBURG","mstate":"VA","mzip":"24501-2205","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z34.82","R03.0","Z34.83","O13.9","Z30.2","Z11.3","N89.8","O80","Z01.419","M79.605","Z11.4","Z91.048","J11.1","J02.0","O26.899","O99.89","R51","Z3A.35","R10.9","R12","Z3A.37","O99.820","Z02.82","J02.9","J21.9","Z82.5","A08.4","R10.12","O26.893","R07.9","R06.02","Z3A.31","Z79.82","L25.9","N76.0","Z20.828","O72.1","R50.9","H61.22","H60.392","I10","R63.5","Z78.9","R51.9","G47.09","R07.1","Z3A.36","M54.9","P39.1","J47.9","R22.41","S39.012A","Z34.02","Z87.59","O13.4","O99.824","O69.81X0","Z37.0","Z3A.38","Z82.49","Z83.3","Z82.61","R59.1","Z12.4","M79.671","J30.2","F33.1","R53.83"],"date":["2019-01-10","2019-03-26","2019-03-29","2019-03-31","2019-03-31","2021-03-01","2021-03-01","2019-07-09","2021-01-12","2019-07-25","2021-03-01","2019-11-15","2019-02-12","2019-02-12","2019-03-21","2019-03-26","2019-10-02","2019-03-15","2019-03-21","2019-01-10","2019-03-26","2019-03-26","2019-02-05","2019-07-02","2019-09-22","2019-09-22","2021-05-05","2019-02-08","2019-02-13","2019-02-13","2019-02-13","2019-02-13","2019-02-13","2019-08-14","2021-01-12","2021-02-01","2019-04-18","2019-09-22","2019-10-02","2019-10-02","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2019-02-13","2019-03-21","2019-03-21","2019-04-06","2019-09-24","2020-11-24","2021-01-26","2019-01-10","2019-02-07","2019-03-30","2019-03-30","2019-03-30","2019-03-30","2019-03-30","2019-03-30","2019-03-30","2019-03-30","2019-07-03","2019-07-09","2019-09-12","2021-02-01","2021-02-01","2021-02-01"],"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":[["","33342032915","TRIAMCINOLON ","CRE 0.001","15","Select","Select",""],["","51672404801","CLOTRIM\/BETA ","CRE DIPROP","15","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","90","Select","Select",""],["","10135012301","ACETAMIN ","TAB 325MG","90","Select","Select",""],["","50111064801","FLUOXETINE ","CAP 20MG","30","Select","Select",""],["","23155000810","HYDROCHLOROT ","TAB 25MG","90","Select","Select",""],["","00574110404","BROM\/PSE\/DM ","SYP ","200","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","20","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","48","Select","Select",""],["","50111056001","TRAZODONE ","TAB 50MG","90","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","17478071130","LIDOCAINE ","GEL 2% JELLY","30","Select","Select",""],["","70710101002","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","00603158758","PROMETH ","SOL PLAIN","120","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","20","Select","Select",""],["","00603459321","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","24208063562","NEO\/POLY\/HC ","SUS 1% OTIC","10","Select","Select",""],["","70710122600","AMITRIPTYLIN ","TAB 25MG","90","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","31604001718","MAGNESIUM ","TAB 250MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","28","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","51672130406","TERCONAZOLE ","CRE 0.004","45","Select","Select",""],["","71093014105","METHOCARBAM ","TAB 750MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","16","Select","Select",""],["","00781185220","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","16571020106","DICLOFENAC ","75MG DR","60","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","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":""}]}]}