{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHIRENA VENEY","gend":1,"add":"713   WILSON STREET                                         ","city":"PETERSBURG                    ","state":"VA","zip":"23803-2667","dob":"1985-04-30","age":"","mstatus":"","insh":10160362,"cliId":"","pno":8045938421,"cno":8047211851,"email":"","ename":"","eno":"","pphy":"ENDE, MARK                                                  ","ppno":"","pcpadd":"121 S Market St,Ste 511","pcpcity":"Petersburg                    ","pcpstate":"VA","pcpzip":238034217,"pcpcounty":"","pcpid":"P0060267","pcpname":"ENDE MEDICAL PRACTICE LLP","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"APARTMENT 3                                                 ","add3":"","madd1":"713   WILSON STREET                                         ","madd2":"APARTMENT 3                                                 ","madd3":"","mcity":"PETERSBURG                    ","mstate":"VA","mzip":"23803-2667","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O26.893","R10.9","Z3A.00","Z33.1","R51","R56.9","G43.909","F17.210","Z88.8","B34.9","R09.81","R04.2","F17.200","R42","M54.5","M47.816","W18.30XA","M25.572","S93.402A","W22.8XXA","X50.9XXA","Y93.01","R07.2","R07.9","F33.2","G47.9","G43.009","R05","R06.02","F33.3","F41.0","M54.6","I49.9","W19.XXXA","M25.511","S39.012A","S40.011A","G40.909","R55","N93.8","N93.9","R10.2","M54.9","F31.9","F32.9","J41.0","Z68.41","F41.9","R47.82","J18.9","R50.9","J98.11","E66.01","M25.50","R21","M79.10","F34.81","F60.3","F43.10","F41.8","Z20.828","N92.0","R35.0","M79.89","V49.59XA","Y92.488","M75.41","F31.63","G89.29","M25.372","J02.9","R93.0","Z20.822","Z79.899","R51.9","M76.72","M67.472","M77.52","Z87.898","F31.64","F60.5","F40.01","Z00.00","Z11.59","M89.9"],"date":["2019-05-11","2021-04-22","2019-05-11","2019-05-11","2020-03-07","2021-10-28","2019-05-20","2021-09-12","2019-05-20","2020-03-27","2020-03-27","2019-05-28","2021-04-22","2021-09-12","2021-07-20","2019-06-05","2019-06-05","2021-08-17","2021-06-21","2019-10-24","2019-06-05","2019-06-05","2019-09-10","2021-09-12","2019-07-23","2019-07-23","2019-10-04","2020-03-27","2021-09-12","2019-10-04","2019-10-04","2021-04-22","2019-10-24","2019-10-24","2021-07-20","2019-10-24","2019-10-24","2020-01-20","2021-10-28","2021-01-14","2021-01-14","2020-02-06","2020-02-06","2020-03-12","2020-03-12","2020-03-12","2021-10-12","2020-03-12","2020-03-16","2020-04-02","2020-03-27","2020-03-27","2020-04-02","2020-05-15","2020-05-15","2020-05-15","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2020-07-16","2021-01-14","2021-04-22","2021-06-21","2021-06-21","2021-06-21","2021-07-20","2021-07-02","2021-07-02","2021-10-05","2021-09-12","2021-10-28","2021-09-12","2021-09-12","2021-09-12","2021-10-11","2021-10-11","2021-10-05","2021-10-28","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-12","2021-10-28"],"priorHcc":["","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","65862085901","FAMOTIDINE","20MG","60","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","45802006435","TRIAMCINOLON","0.10%","15","Select","Select",""],["","31722053705","LEVETIRACETA","500MG","60","Select","Select",""],["","31722082030","ARIPIPRAZOLE","5MG","30","Select","Select",""],["","27241009803","DULOXETINE","30MG","30","Select","Select",""],["","68382013805","TOPIRAMATE","25MG","30","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","65862037401","ESCITALOPRAM","10MG","30","Select","Select",""],["","00363033601","ACETAMINOPHEN","R 650MG","100","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","00378110101","PRAZOSIN","1MG","30","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","10","Select","Select",""],["","23155050201","HYDROXYZ","50MG","60","Select","Select",""],["","65862090801","CELECOXIB","100MG","60","Select","Select",""],["","65862001205","SERTRALINE","50MG","30","Select","Select",""],["","60505265301","TRAZODONE","50MG","30","Select","Select",""],["","70010075401","METHOCARBAM","500MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","15","Select","Select",""],["","68462019005","NAPROXEN","500MG","20","Select","Select",""],["","49884072703","DOXYCYC","100MG","14","Select","Select",""],["","65162062711","TRAMADOL","50MG","12","Select","Select",""],["","00363017529","PAIN","500MG","30","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","45802006435","TRIAMCINOLON ","CRE 0.001","15","Select","Select",""],["","31722053705","LEVETIRACETA ","TAB 500MG","60","Select","Select",""],["","31722082030","ARIPIPRAZOLE ","TAB 5MG","30","Select","Select",""],["","43547034050","RISPERIDONE ","TAB 0.5MG","60","Select","Select",""],["","68180013601","ESCITALOPRAM ","TAB 20MG","30","Select","Select",""],["","27241009803","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","68382013805","TOPIRAMATE ","TAB 25MG","30","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","00363033601","ACETAMINOPHEN ","8H R 650MG","100","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","00378110101","PRAZOSIN ","CAP 1MG","30","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","23155050201","HYDROXYZ ","TAB 50MG","60","Select","Select",""],["","65862090801","CELECOXIB ","CAP 100MG","60","Select","Select",""],["","69315090405","LORAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","60505265301","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","49884072703","DOXYCYC ","CAP 100MG","14","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","12","Select","Select",""],["","00363017529","PAIN ","TAB 500MG","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":""}]}]}