{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICKIETTA   J ARMWOOD","gend":1,"add":"10961   WEST BROAD STREET                                   ","city":"GLEN ALLEN                    ","state":"VA","zip":"23060-5935","dob":"1978-04-03","age":"","mstatus":"","insh":1265158,"cliId":"","pno":8048991598,"cno":8042978394,"email":"","ename":"","eno":"","pphy":"GLADFELTER, BAMBI L                                         ","ppno":"","pcpadd":"12018 W Broad St Ste 100","pcpcity":"Henrico                       ","pcpstate":"VA","pcpzip":232337796,"pcpcounty":"","pcpid":"P0114248","pcpname":"PRIMARY CARE OF WEST END LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"RM 260                                                      ","add3":"","madd1":"10961   WEST BROAD STREET                                   ","madd2":"RM 260                                                      ","madd3":"","mcity":"GLEN ALLEN                    ","mstate":"VA","mzip":"23060-5935","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G40.219","M47.22","M25.511","G44.209","R13.10","M54.2","I10","R56.9","M79.601","R51","M54.12","G47.00","G40.209","D50.9","E53.8","R94.6","Z87.11","Z23","D64.9","G40.909","R53.83","Z01.419","Z11.51","K27.9","M19.011","Z79.899","Z12.31","R29.6","F32.9","F41.9","R94.31","R10.13","R63.4","K62.5","M79.641","M79.642","M79.674","R73.02","Z13.9","M25.50","M19.072","M21.071","M79.671","M20.11","M21.271","M19.071","M77.31","Z20.828","D51.9","Z72.0","K08.89","Z01.812","Z11.59","D12.2","K92.1","K62.89","K64.4","K64.8","K57.30","K31.89","K29.50","K63.89","M06.9","E61.1","G40.019","E66.9","Z68.32","Z87.19","M25.552","M05.9","M79.606","M54.9","M79.605","M89.38","Z20.822","M47.816","M54.30","Z86.69","N92.0","N93.9","R00.2","R10.31","R00.0","M06.00","N92.1","M54.32"],"date":["2019-09-10","2019-05-13","2019-07-01","2019-05-13","2019-05-13","2019-05-30","2019-10-01","2019-10-01","2019-05-13","2019-05-13","2019-05-13","2019-05-30","2019-05-30","2021-11-04","2021-10-28","2019-05-30","2019-05-30","2021-10-28","2020-10-29","2019-10-01","2019-05-30","2020-11-09","2019-06-13","2019-06-24","2019-07-01","2021-05-07","2021-02-16","2019-10-01","2019-10-01","2019-10-01","2019-10-01","2021-11-04","2020-09-18","2021-05-07","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2021-01-04","2020-12-22","2020-12-22","2021-03-05","2021-03-06","2021-03-06","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-11-18","2021-08-26","2021-05-04","2021-05-07","2021-05-07","2021-05-07","2021-05-14","2021-08-26","2021-05-20","2021-05-20","2021-05-20","2021-05-20","2021-08-17","2021-11-18","2021-08-26","2021-11-18","2021-09-24","2021-11-10","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-10","2021-11-18"],"priorHcc":["","","","","","","","","","","","","",null,"","","",null,"","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","",null,"",null,"",null,null,null,null,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":[["","59651000305","OMEPRAZOLE","40MG","30","Select","Select",""],["","69315012710","FOLIC","1000MCG","90","Select","Select",""],["","00536100901","FERROUS","325MG","30","Select","Select",""],["","00378064110","PREDNISONE","10MG","30","Select","Select",""],["","65862023060","LAMOTRIGINE","200MG","60","Select","Select",""],["","69097012503","TOPIRAMATE","200MG","60","Select","Select",""],["","43598072101","HYDROXYCHLOR","200MG","60","Select","Select",""],["","50428037624","VITAMIN","1000MCG","90","Select","Select",""],["","69097052444","DICLOFENAC","1%","200","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","50428009256","GENTLE","5MG EC","4","Select","Select",""],["","59779030601","CVS","","238","Select","Select",""],["","00603188016","LIDOCAINE","5%","14","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","90","Select","Select",""],["","00555077902","MEDROXYPR ","TAB 10MG","60","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","30","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","30","Select","Select",""],["","65862023060","LAMOTRIGINE ","TAB 200MG","60","Select","Select",""],["","69097012503","TOPIRAMATE ","TAB 200MG","60","Select","Select",""],["","43598072101","HYDROXYCHLOR ","TAB 200MG","60","Select","Select",""],["","50428037624","VITAMIN ","TAB 1000MCG","90","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","200","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","50428009256","GENTLE ","TAB 5MG EC","4","Select","Select",""],["","59779030601","CVS ","POW ","238","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","14","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":""}]}]}