{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISA   J JAMES","gend":1,"add":"C\/O VIRGINIA HOME FOR ADULTS","city":"CHESAPEAKE","state":"VA","zip":"23324-3715","dob":"1960-04-04","age":"","mstatus":"","insh":10128201,"cliId":"","pno":7575456219,"cno":"               ","email":"","ename":"","eno":"","pphy":"WHALEN, RICHARD M","ppno":7574465955,"pcpadd":"825 Fairfax Ave, Ste 118","pcpcity":"Norfolk","pcpstate":"VA","pcpzip":235071914,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":7575459409,"add2":"2701 BORDER ROAD","add3":"","madd1":"C\/O VIRGINIA HOME FOR ADULTS","madd2":"2701 BORDER ROAD","madd3":"","mcity":"CHESAPEAKE","mstate":"VA","mzip":"23324-3715","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.1","R05","R09.81","R06.2","F41.9","F03.90","E11.40","F32.9","G89.29","F17.210","Z79.899","Z88.0","F33.1","L03.115","L03.116","R68.89","F33.2","G62.9","E55.9","R41.3","G47.9","B35.1","I70.209","M79.676","R60.9","R39.81","M62.81","R07.9","F32.89","G57.93","R26.9","R53.1","R29.6","R06.02","R19.7","R60.0","F20.9","M79.89","L53.9","J44.9","R22.40","F02.80","R06.83","L11.0","M20.40","M19.079","I95.9","R60.1","F41.1","D89.2","R79.89","E87.1","R09.02","J96.01","J96.02","A41.9","N17.9","R26.2","I51.7","Z04.3","Z03.89","M54.2","J90","G47.30","J98.8","R91.8","Z20.828","N39.0","R71.8","R53.0","Z12.2","J06.9","M19.90","F01.50","F33.0","G47.33","F05","G60.9","E03.9","D72.829","R13.10","R31.29","R32","R41.82","R53.83","Z86.59","R63.8","B96.4","E87.6","F31.9","I87.2","F10.21","R26.89","R50.9","R91.1","J43.2","Z87.891"],"date":["2020-11-02","2020-11-02","2019-01-15","2020-11-02","2020-11-06","2020-09-29","2019-01-15","2019-01-15","2019-01-15","2020-11-02","2019-01-15","2019-04-20","2020-03-10","2019-04-20","2019-04-20","2020-09-29","2020-08-23","2020-11-02","2019-07-07","2019-11-26","2019-06-12","2021-03-30","2021-03-30","2021-03-30","2020-09-25","2021-05-11","2021-05-11","2020-09-26","2019-02-10","2019-02-10","2019-02-10","2020-09-30","2019-02-10","2020-11-02","2019-03-23","2019-03-23","2020-09-23","2019-04-20","2019-04-20","2020-09-29","2019-04-20","2019-04-20","2019-07-07","2021-03-30","2021-03-30","2021-03-30","2020-11-02","2019-03-23","2019-08-27","2019-06-20","2019-03-23","2020-09-29","2020-11-02","2020-09-29","2020-09-29","2020-09-29","2020-09-27","2020-09-10","2020-09-27","2020-11-04","2020-11-05","2020-11-04","2020-11-04","2019-07-07","2019-07-07","2020-09-23","2020-11-23","2020-11-02","2019-06-20","2019-06-20","2020-06-01","2019-03-19","2019-03-19","2019-06-14","2019-06-14","2019-07-07","2020-09-23","2020-09-23","2020-11-02","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-11-02","2020-09-28","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2019-01-15","2019-04-26","2019-04-26","2020-06-01"],"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":[["","57237017601","VENLAFAXINE ","TAB 100MG","62","Select","Select",""],["","65162089809","ARIPIPRAZOLE ","TAB 10MG","31","Select","Select",""],["","43547027611","DONEPEZIL ","TAB 10MG","31","Select","Select",""],["","16729018217","HYDROCHLOROT ","TAB 12.5MG","30","Select","Select",""],["","68462012605","GABAPENTIN ","TAB 600MG","150","Select","Select",""],["","69315011710","FUROSEMIDE ","TAB 40MG","60","Select","Select",""],["","00143973810","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","20","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","67877012450","SILVER ","CRE 0.01","100","Select","Select",""],["","00093100301","BUSPIRONE ","TAB 15MG","93","Select","Select",""],["","00378180310","LEVOTHYROXIN ","TAB 50MCG","31","Select","Select",""],["","00832532515","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","00781577626","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","51672129803","KETOCONAZOLE ","CRE 0.02","60","Select","Select",""],["","69315090510","LORAZEPAM ","TAB 1MG","60","Select","Select",""],["","00904671980","ACETAMINOPHEN ","TA B 325","22","Select","Select",""],["","55111028050","LEVOFLOXACIN ","TAB 500MG","5","Select","Select",""],["","00536589588","NICOTINE ","DIS 14MG\/24H","14","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","00904772512","ANTI-DIARRHE ","TAB 2MG","20","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","68180065208","DOXYCYC ","CAP 100MG","14","Select","Select",""],["","00603158658","PROMETHAZINE ","SYP DM","120","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","10","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","30768048678","MELATONIN ","TAB 3MG","30","Select","Select",""],["","33332032001","AFLURIA ","INJ 2020-21","0.5","Select","Select",""],["","69238131209","PREGABALIN ","75MG","60","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","4","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":""}]}]}