{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"QUANTRE   D FITZGERALD","gend":0,"add":"1227 W ADMIRAL STREET","city":"RICHMOND","state":"VA","zip":"23220-1701","dob":"1994-10-06","age":"","mstatus":"","insh":10188970,"cliId":"","pno":8046770468,"cno":8044428063,"email":"","ename":"","eno":"","pphy":"MAJHI, SHWETA","ppno":8042307777,"pcpadd":"4730 N Southside Plaza St # Ref, ","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232241742,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":8044428063,"add2":"APT D","add3":"","madd1":"1227 W ADMIRAL STREET","madd2":"APT D","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23220-1701","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F19.129","S41.151D","M79.622","Z87.891","S60.221A","W22.09XA","F41.9","R45.851","J18.9","K59.00","J45.909","F39","F41.1","I49.9","F31.4","F90.2","S61.552A","Z20.3","W54.0XXA","Z29.14","F17.200","M25.512","J18.0","R06.00","R07.9","Z20.828","J20.9","K02.7","K04.7","Z48.00","W54.0XXD","Z23","S61.552D","S60.212A","S49.92XA","Y04.8XXA","S50.812A","R09.89","R05","R11.2","Z20.822","F32.9","R19.7","G47.00","R10.32","R00.2","M94.0","R07.89","Z53.21","R22.2","M79.89","Z20.2","M79.641","R59.9","R52","F14.29","S59.912A","W22.8XXA","K02.9","R45.4","I10","M54.9","M25.562","Z76.89","G89.29","Z68.20","J32.9","R09.81","F33.2","Z91.410","Z88.0","Z79.899","Z79.51","Z79.2","R06.02","D48.1"],"date":["2021-05-20","2021-05-20","2019-11-15","2019-11-24","2019-12-24","2019-12-11","2019-12-11","2021-01-04","2019-12-13","2019-12-13","2019-12-13","2021-01-04","2019-12-15","2019-12-15","2019-12-25","2020-11-11","2021-05-16","2019-10-29","2019-10-29","2019-10-29","2019-11-27","2020-04-23","2019-12-08","2019-12-12","2019-12-12","2019-12-26","2021-01-04","2021-01-04","2021-03-26","2021-03-26","2019-11-15","2019-11-15","2019-11-15","2019-11-27","2020-04-23","2020-04-23","2020-04-23","2020-04-23","2021-01-04","2021-01-04","2021-01-04","2021-01-04","2021-01-04","2019-12-10","2019-12-24","2019-12-11","2019-12-18","2019-12-24","2019-12-24","2019-12-25","2020-02-06","2020-02-06","2021-01-28","2019-12-11","2020-02-06","2021-03-01","2019-08-26","2020-04-23","2020-04-23","2021-03-26","2019-07-08","2019-12-13","2019-07-08","2019-07-08","2019-07-08","2019-07-08","2019-07-08","2019-12-03","2019-12-03","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2019-12-18","2020-02-06"],"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":[["","16714008310","HYDROXYZ ","TAB 50MG","30","Select","Select",""],["","00832712311","DIVALPROEX ","TAB 250MG DR","60","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","63304069201","CLINDAMYCIN ","CAP 150MG","63","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","67877057505","BENZONATATE ","CAP 200MG","20","Select","Select",""],["","00179831550","PSEUDOEPHEDR ","TAB 60MG","24","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","64679096105","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00591024110","LORAZEPAM ","TAB 1MG","10","Select","Select",""],["","50428209452","MAG ","SOL LEMON","296","Select","Select",""],["","45802086802","POLYETH ","POW 3350 NF","238","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","21","Select","Select",""],["","31722094101","HYDROCO\/APAP ","TAB 5-325MG","15","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","68462019001","NAPROXEN ","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":""}]}]}