{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" LEVON A DAVIS","gend":0,"add":"3501 GRIFFIN AVENUE","city":"RICHMOND","state":"VA","zip":"23222-1913","dob":"1987-07-01","age":"","mstatus":"","insh":10236518,"cliId":"","pno":"4346583774, 4346583774","cno":"","email":"","ename":"","eno":"","pphy":"BECKWITH, DOUGLAS E","ppno":"               ","pcpadd":"12901 Briggs Rd, ","pcpcity":"Chester","pcpstate":"VA","pcpzip":238315335,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"6900 ATMORE DR","add3":"","madd1":"3501 Griffin Ave","madd2":"                                                            ","madd3":"","mcity":"Richmond","mstate":"VA","mzip":"23222-1913","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.0","T83.9XXA","J45.909","G83.9","Z87.891","Z79.899","Z45.2","L89.622","L89.314","T83.098A","L89.159","D72.829","L97.429","R82.90","D64.9","R63.4","M86.9","M86.68","M86.60","R00.0","G82.22","L89.602","L89.224","L89.324","L89.623","G82.20","Z71.3","R50.9","A41.9","L89.154","D50.0","E87.1","S31.809A","T83.511A","F17.200","Z46.6","M20.12","M62.572","M86.652","K62.89","Z03.89","N50.82","N43.3","N49.2","R82.81","T83.031A","T83.038A","Y92.89","F17.210","Z88.6","Z88.5","S71.101A","X58.XXXA","R52","M62.3","S31.109A","T83.89XA","G89.29","Z76.0","T88.7XXA","R19.7","T83.028A","T83.021A","Y84.6","L89.894","N50.89","T83.018A","R33.9","M46.28","E44.0","L97.109","M86.48","M86.672","L89.629","E87.6","D63.8","S24.103S","W34.00XS","Z53.20","R53.1","Z20.828","R61","N50.819","Z96.642","N31.9","Z79.51","S31.829A","R65.10","W26.8XXA","Y73.1","T50.905A","T83.011A","X95.9XXS","Z99.3","K59.00","S24.153S","Z88.1","F39","Z87.440","Z82.5","T14.8XXS","N36.5","J45.20","Z87.442","M79.5","N39.8","S00.451A","L08.9","Z86.69","M86.8X6","L98.416"],"date":["2021-04-22","2021-04-22","2021-05-11","2020-06-05","2021-05-11","2021-05-11","2021-01-16","2020-10-26","2020-12-26","2020-11-24","2020-09-06","2020-12-27","2020-09-05","2020-09-05","2020-12-26","2020-09-05","2020-09-16","2020-09-16","2020-12-29","2020-11-24","2020-10-25","2020-10-25","2020-10-25","2020-12-28","2020-10-05","2021-05-11","2020-10-05","2020-10-28","2020-12-27","2021-04-08","2020-12-27","2020-12-27","2020-12-29","2021-04-22","2020-12-26","2020-12-30","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-10-26","2020-12-30","2020-12-26","2020-12-30","2020-12-30","2020-11-24","2020-07-03","2020-11-24","2020-09-06","2020-11-24","2020-12-26","2020-09-04","2021-04-22","2020-10-26","2020-09-12","2020-10-28","2020-07-03","2020-10-27","2020-09-16","2021-01-16","2021-01-16","2021-05-11","2021-05-11","2021-05-11","2021-04-08","2020-12-30","2020-04-08","2020-04-08","2020-12-28","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-12-29","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-10-26","2020-12-26","2020-11-28","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2020-12-27","2020-12-27","2020-12-27","2021-01-16","2021-01-16","2020-04-08","2020-12-28","2020-12-28","2020-09-06","2020-09-06","2020-11-24","2020-09-06","2020-11-24","2020-11-24","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2020-05-01","2020-10-27","2020-12-28"],"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":[["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","16571041210","CIPROFLOXACN ","TAB 500MG","2","Select","Select",""],["","65162047810","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","10","Select","Select",""],["","00143928501","AMOXICILLIN ","TAB 875MG","56","Select","Select",""],["","16714039401","CEFPODOXIME ","TAB 100MG","14","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","00713028031","BACITRACIN ","OIN 500\/GM","28.4","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}