{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" FRANKLIN D GOSS JR","gend":0,"add":"260 BAPTIST VALLEY ROAD","city":"Cedar Bluff","state":"VA","zip":"24609-8629","dob":"1956-02-15","age":"","mstatus":"","insh":10218125,"cliId":"","pno":"2762457575, 2762457575","cno":"","email":"","ename":"","eno":"","pphy":"UNKNOWN PROVIDER QNXT PCP","ppno":"               ","pcpadd":"UNKNOWN STREET, ","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":232190000,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"260 BAPTIST VALLEY ROAD","madd2":"                                                            ","madd3":"","mcity":"Cedar Bluff","mstate":"VA","mzip":"24609-8629","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.00","R53.1","R05","I50.42","I48.0","J93.0","J96.01","J44.1","T79.7XXA","F17.210","I11.0","I50.9","E78.5","M19.90","Z79.82","Z79.4","Z79.899","R07.9","J93.9","Z43.8","J93.83","Z93.8","J44.9","T81.41XA","I50.22","E11.9","I44.7","K35.80","J81.1","J90","R22.41","J93.11","G89.18","Z03.89","Z01.818","R94.31","I95.9","F17.200","R91.8","J43.9","S27.0XXA","R68.89","I25.10","R60.0","I51.7","Z99.11","J96.90","I42.0","J18.1","J18.9","Y95","I50.23","M79.89","I42.8","I51.9","Z01.89","R00.0","I45.4","I11.9","R10.84","R06.02","J95.821","A41.9","N17.9","I48.91","R09.02","E11.65","Z12.11","Z46.82","J98.11","J93.82","Z98.890","I27.20","J98.2","D72.829","I10","I48.20","I50.32","Z96.89","J84.10","I47.1","E78.00","E78.2","I50.20","Y92.239","Y84.8","I95.89","E11.51","D62","E27.40","E83.42","E87.1","R50.9","T38.0X5A","Z09","R09.89","N28.9","Z91.14","R79.89"],"date":["2020-06-09","2020-01-14","2020-04-27","2020-07-10","2020-05-21","2020-09-01","2020-06-09","2020-06-10","2020-06-14","2020-06-25","2020-09-01","2020-12-03","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2020-06-16","2020-07-07","2020-07-07","2020-08-27","2020-07-03","2020-12-03","2020-09-01","2020-09-01","2020-09-01","2020-02-11","2020-01-04","2020-01-04","2020-07-06","2020-05-21","2020-06-09","2020-06-09","2020-06-19","2020-06-18","2020-07-03","2020-06-23","2020-06-23","2020-07-05","2020-08-27","2020-07-04","2020-07-07","2020-07-10","2020-07-10","2020-08-27","2020-01-03","2020-01-03","2020-01-14","2020-01-14","2020-01-17","2020-01-14","2020-08-27","2020-05-21","2020-07-10","2020-07-10","2020-06-29","2020-07-03","2020-07-03","2020-09-16","2020-01-01","2020-05-21","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2020-06-09","2020-03-04","2020-02-05","2020-06-16","2020-06-16","2020-06-22","2020-07-05","2020-02-11","2020-06-20","2020-06-16","2020-07-06","2020-01-14","2020-05-21","2020-06-25","2020-08-27","2020-01-02","2020-02-11","2020-02-11","2020-07-06","2020-06-16","2020-06-16","2020-06-16","2020-06-16","2020-06-16","2020-06-16","2020-06-16","2020-06-16","2020-06-16","2020-06-16","2020-08-27","2020-08-27","2020-01-01","2020-01-01","2020-01-14"],"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":[["","60505257809","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","42858000101","OXYCODONE ","TAB 5MG","28","Select","Select",""],["","00078065920","ENTRESTO ","TAB 24-26MG","30","Select","Select",""],["","67877022305","GABAPENTIN ","CAP 300MG","180","Select","Select",""],["","68180012201","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","69315011710","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","69618004610","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","49281012065","FLUZONE ","INJ PF 20-21","0.7","Select","Select",""],["","00005197105","PREVNAR ","INJ ","0.5","Select","Select",""],["","00185005501","METOLAZONE ","TAB 5MG","7","Select","Select",""],["","00603533815","PREDNISONE ","PAK 10MG","21","Select","Select",""],["","42806031250","DOXYCYCL ","TAB 100MG","14","Select","Select",""],["","64380071207","BENZONATATE ","CAP 100MG","90","Select","Select",""],["","55111046605","METOPROL ","TAB 25MG ER","30","Select","Select",""],["","42571016201","AMOX\/K ","TAB 875-125","10","Select","Select",""],["","08470353001","UNIFINE ","MIS 31GX8MM","30","Select","Select",""],["","68382009205","CARVEDILOL ","TAB 3.125MG","60","Select","Select",""],["","76204060001","IPRATROPIUM\/ ","SOL ALBUTER","360","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","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":""}]}]}