{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" EDWARD S BAILEY SR","gend":0,"add":"2173 MATIAS POINT ROAD","city":"KING GEORGE","state":"VA","zip":"22485-6025","dob":"1956-08-26","age":"","mstatus":"","insh":10193581,"cliId":"","pno":5406633310,"cno":5408408709,"email":"","ename":"","eno":"","pphy":"DEDWYLDER, ROSIER D","ppno":"               ","pcpadd":"5254 Potomac Dr, Ste C","pcpcity":"King George","pcpstate":"VA","pcpzip":224855832,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"2173 MATIAS POINT ROAD","madd2":"                                                            ","madd3":"","mcity":"KING GEORGE","mstate":"VA","mzip":"22485-6025","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G83.13","R68.89","R11.2","K92.0","I12.9","N18.9","E11.22","E78.5","N40.0","R06.6","R13.12","Z11.59","Z79.4","Z79.82","Z79.02","Z87.892","Z87.891","Z86.73","R41.82","R29.6","M25.551","K29.60","I95.1","I13.0","I50.42","N18.30","I69.391","I69.351","E11.51","E11.40","H54.8","M48.07","D63.1","D49.6","Z46.6","N40.1","R33.8","N13.8","N18.3","I25.10","M51.37","N17.9","N39.0","E86.0","R32","B96.89","Z82.49","Z83.3","H53.8","R20.9","R53.1","K59.00","E11.9","D64.9","R63.4","I10","Z99.3","R10.9","R53.83","R33.9","K92.2","N18.31","E11.01","E11.3513","I63.9","H40.9","E11.3533","R07.9","K29.51","I63.89","E10.3541","H43.11","E08.3592","R42","R53.81","N28.9","G45.9","H54.61"],"date":["2021-05-18","2020-01-01","2020-04-21","2020-09-30","2020-10-15","2020-10-16","2020-10-15","2020-08-17","2020-08-17","2020-11-02","2020-11-02","2020-08-17","2020-10-15","2020-10-15","2020-10-15","2020-08-17","2021-05-03","2021-05-03","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-04-21","2020-08-04","2020-09-01","2020-08-09","2020-09-01","2020-09-18","2020-09-01","2020-08-04","2020-08-09","2020-09-01","2020-08-09","2020-08-09","2020-09-01","2021-05-03","2020-10-15","2020-04-24","2020-04-24","2020-10-16","2020-07-13","2021-05-03","2020-07-15","2020-07-13","2021-05-03","2020-10-15","2020-07-13","2020-07-13","2020-08-06","2020-08-19","2020-10-15","2020-10-15","2020-06-08","2020-10-16","2021-05-03","2020-06-08","2020-08-17","2020-08-19","2020-10-15","2020-06-08","2020-07-30","2020-06-08","2020-07-13","2020-07-13","2020-08-06","2020-10-15","2020-10-15"],"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":[["","61314054701","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","00115703301","FLUDROCORT ","TAB 0.1MG","30","Select","Select",""],["","16729018201","HYDROCHLOROT ","TAB 12.5MG","30","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","50742061510","METOPROL ","TAB 25MG ER","30","Select","Select",""],["","70069023101","BRIMONIDINE ","SOL 0.2% OP","10","Select","Select",""],["","70069005101","DORZOL\/TIMOL ","SOL 22.3-6.8","10","Select","Select",""],["","00245021311","MIDODRINE ","TAB 10MG","90","Select","Select",""],["","64380083406","ACETAZOLAMID ","TAB 250MG","30","Select","Select",""],["","60758011905","PREDNISOLONE ","SUS 1% OP","5","Select","Select",""],["","65862014305","CARVEDILOL ","TAB 6.25MG","60","Select","Select",""],["","45802086866","POLYETH ","POW 3350 NF","3","Select","Select",""],["","17478071310","OFLOXACIN ","DRO 0.3% OP","5","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","57896044405","BISACODYL ","SUP 10MG","10","Select","Select",""],["","49035089212","NATURAL ","TAB 8.6MG","60","Select","Select",""],["","00527193206","CLARITHROMYC ","TAB 500MG","28","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","56","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":""}]}]}