{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" VENITA  BARNETT","gend":1,"add":"P. O. BOX 12004","city":"DANVILLE","state":"VA","zip":"24543-5034","dob":"1962-06-05","age":"","mstatus":"","insh":3208662,"cliId":"","pno":"7578315134, 7578315134","cno":"","email":"","ename":"","eno":"","pphy":"SEEPE, CAROLYN S","ppno":"               ","pcpadd":"201 SOUTH MAIN STREET, SUITE 300","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":245412957,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"WESTERN","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"P. O. BOX 12004","madd2":"                                                            ","madd3":"","mcity":"DANVILLE","mstate":"VA","mzip":"24543-5034","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.40","G47.30","R49.0","I10","E66.01","Z68.42","R06.02","E78.2","R07.89","R60.0","J45.21","G47.33","Z87.09","M47.816","M51.26","M54.5","Z87.39","I69.30","J44.9","B35.1","Z23","I87.2","M79.7","Z99.81","Z91.013","Z98.890","R51","M13.0","Z79.899","F33.3","Z11.1","F32.2","E55.9","E53.8","R13.19","J45.909","K21.9","J30.0","R91.1","R07.9","F43.10","H57.11","R03.0","H93.11","F33.1","J30.2","E66.3","Z28.89","J45.998","J40","B37.9","H65.01","Z12.31","Z99.89","R05","I83.891","M79.604","M94.0","M54.2","M25.561","M25.562","R68.89","J30.89","G50.1","Z82.5","R06.2","R06.83","M54.16","M53.3","M79.18","G89.29","Z79.891","M51.36","R53.83","H66.001","F51.04","R26.2","K08.89","A60.00","G43.909","Z76.0","I83.892","M79.605","Z91.410","M47.817","Z91.81","Z76.89"],"date":["2020-12-08","2020-05-06","2020-11-23","2021-05-13","2021-05-13","2019-12-17","2020-12-08","2020-12-08","2019-06-28","2020-05-06","2019-09-08","2021-05-13","2019-09-17","2021-03-19","2019-12-11","2021-03-19","2020-03-18","2020-02-03","2021-05-13","2020-05-20","2020-10-21","2020-05-15","2020-10-27","2021-05-13","2020-03-10","2020-05-15","2019-07-19","2020-10-27","2021-01-07","2019-12-13","2019-12-03","2020-06-17","2020-10-27","2020-10-27","2020-11-23","2021-05-13","2021-05-13","2020-11-23","2021-04-28","2021-04-28","2019-06-11","2019-06-10","2019-06-10","2019-06-20","2019-07-08","2021-05-13","2020-05-12","2020-05-12","2020-03-18","2019-05-01","2019-05-01","2019-05-24","2019-09-30","2020-01-03","2020-01-03","2020-05-06","2020-05-06","2019-06-19","2020-01-17","2019-11-13","2019-11-13","2019-12-11","2020-01-28","2020-10-21","2019-05-31","2019-05-31","2019-05-31","2021-01-07","2020-01-17","2020-01-17","2020-01-17","2020-05-12","2021-03-19","2019-05-30","2020-03-02","2020-06-18","2020-09-21","2020-09-21","2021-05-13","2021-05-13","2021-05-13","2020-03-10","2020-03-10","2020-05-20","2021-01-07","2021-01-07","2021-01-07"],"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":[["","00591544243","PREDNISONE ","PAK 10MG","48","Select","Select",""],["","76204060060","IPRATROPIUM\/ ","SOL ALBUTER","360","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","90","Select","Select",""],["","68382050010","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","74312003860","VITAMIN ","SUB 2500MCG","90","Select","Select",""],["","00378427677","VALACYCLOVIR ","TAB 1GM","30","Select","Select",""],["","65862056090","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","68180031909","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","27241009803","DULOXETINE ","CAP 30MG","90","Select","Select",""],["","13107003134","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","52817033010","CYCLOBENZAPR ","TAB 5MG","30","Select","Select",""],["","00093092810","LOVASTATIN ","TAB 40MG","30","Select","Select",""],["","68462034690","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","00006911754","SINGULAIR ","TAB 10MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","00591292754","LEVALBUTEROL ","AER 45\/ACT","15","Select","Select",""],["","00002324030","CYMBALTA ","CAP 30MG","90","Select","Select",""],["","33342008845","RIZATRIPTAN ","TAB 10MG","9","Select","Select",""],["","23155050001","HYDROXYZ ","TAB 10MG","30","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","65862007930","TERBINAFINE ","TAB 250MG","30","Select","Select",""],["","31722072690","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","100","Select","Select",""],["","70700026390","LANSOPRAZOLE ","CAP 30MG DR","90","Select","Select",""],["","69543025216","VIRTUSSIN ","SOL 100-10\/5","240","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","64380080907","IBUPROFEN ","TAB 400MG","30","Select","Select",""],["","66685100100","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","30","Select","Select",""],["","00054004641","IPRATROPIUM ","SPR 0.0006","15","Select","Select",""],["","68382091634","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","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","",""],["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":""}]}]}