{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEVEN TRENT","gend":0,"add":"1971 SOUTH COOLWELL ROAD","city":"MADISON HEIGHTS","state":"VA","zip":"24572-5953","dob":"1957-08-07","age":"","mstatus":"","insh":10123552,"cliId":"","pno":5409048796,"cno":4349291903,"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":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":4349291903,"add2":"                                                            ","add3":"","madd1":"402 4th St SE","madd2":"c\/o Roanoke Mission","madd3":"","mcity":"Roanoke","mstate":"VA","mzip":"24013-1404","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.51","I10","N52.9","M54.5","R68.89","Z87.2","E11.42","E11.22","N18.9","E78.5","F17.200","Z79.84","F32.9","R45.851","F17.210","J18.1","J96.01","J44.1","I50.31","E11.9","F41.9","F33.2","T38.3X2A","E78.00","Z91.5","Z59.0","I87.8","R03.0","R52","T50.904A","R40.20","T88.7XXA","T14.91XA","J96.21","I11.0","I50.32","J18.9","J20.9","J44.0","Z23","E11.65","I45.10","Z79.899","R06.02","Z11.59","R73.9","H25.13","B35.1","L60.3","B35.3","I89.0","Z12.11","M72.0","A39.9","I50.33","R00.0","I49.1","I45.2","R94.31","T50.902A","F33.1","J96.11","L03.115","L03.116","E11.628","M79.89","D72.829","R60.0","I87.2","I83.023","E11.622","L97.811","L97.821","Z79.1","Z00.01","Z12.5","R05","E87.8","Z72.0","Z79.4","L85.8","F32.1","R06.03","Z20.828","E11.40","I50.9","Z87.01","F29","R06.00","R22.42","H25.813","E11.3299","L97.812","L97.822","I12.9","R90.89","R90.82","G93.89","Z86.73","S19.9XXA","M47.812","R91.8","R07.9","T38.0X5A","E09.65","I27.81","F10.10","Z91.19","R60.9","Z81.1","R13.10","M65.30"],"date":["2019-05-17","2020-01-19","2019-01-14","2019-01-14","2020-05-15","2019-03-21","2020-01-19","2019-03-21","2019-03-21","2019-03-21","2019-05-31","2020-05-14","2021-02-24","2019-05-08","2021-02-26","2019-06-05","2020-01-19","2020-05-14","2020-02-09","2020-01-02","2019-06-04","2020-08-06","2020-01-02","2020-05-14","2019-12-31","2020-05-14","2020-02-08","2019-12-31","2020-02-08","2019-12-31","2019-12-31","2019-12-31","2020-01-03","2020-01-19","2020-05-14","2020-01-19","2020-01-19","2020-01-19","2020-01-19","2020-01-19","2021-02-26","2020-05-14","2020-01-19","2020-05-14","2020-05-14","2020-05-14","2019-01-08","2019-02-22","2021-02-26","2019-02-22","2019-03-18","2019-05-20","2019-05-21","2019-05-31","2020-02-08","2020-02-08","2019-05-31","2019-05-31","2020-01-19","2019-12-31","2020-01-16","2020-02-08","2020-02-09","2020-02-09","2020-02-09","2020-02-08","2020-02-08","2021-02-24","2021-02-26","2021-02-26","2019-02-28","2019-02-28","2019-02-28","2019-04-29","2019-05-20","2019-05-20","2020-05-14","2019-06-05","2020-02-09","2020-02-09","2019-02-14","2019-05-15","2020-01-19","2020-05-14","2020-05-14","2020-05-14","2020-05-14","2019-05-08","2020-01-19","2020-02-08","2021-03-17","2021-03-17","2019-01-02","2019-01-17","2019-01-02","2019-05-08","2019-05-08","2019-05-08","2019-05-08","2019-05-08","2019-05-08","2019-05-31","2020-01-19","2020-01-20","2020-01-20","2020-02-08","2020-02-08","2020-02-08","2020-02-09","2019-05-08","2019-05-17","2019-05-17"],"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":[["","70954006020","PREDNISONE ","TAB 20MG","4","Select","Select",""],["","65862052305","GABAPENTIN ","TAB 600MG","60","Select","Select",""],["","60505014101","GLIPIZIDE ","TAB 5MG","60","Select","Select",""],["","68180051202","LISINOPRIL ","TAB 2.5MG","30","Select","Select",""],["","60505257909","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","66993058597","FLUTIC\/SALME ","AER 250\/50","60","Select","Select",""],["","00597002402","COMBIVENT ","AER 20-100","4","Select","Select",""],["","23155010210","METFORMIN ","TAB 500MG","90","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","5","Select","Select",""],["","24385035926","GNP ","LIQ DM","118","Select","Select",""],["","00487950125","ALBUTEROL ","NEB 0.00083","75","Select","Select",""],["","00487020103","IPRATROPIUM\/ ","SOL ALBUTER","270","Select","Select",""],["","53746051101","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","68645057154","CITALOPRAM ","TAB 40MG","30","Select","Select",""],["","42799012001","BUMETANIDE ","TAB 1MG","30","Select","Select",""],["","00143211250","DOXYCYCL ","TAB 100MG","6","Select","Select",""],["","00536589671","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","50111043303","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","68180037703","LOSARTAN ","TAB 50MG","30","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","00378021601","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","00173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","52565002230","ECONAZOLE ","CRE 0.01","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":""}]}]}