{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BONITA   R MORRISON","gend":1,"add":"709 NORWOOD STREET","city":"LYNCHBURG","state":"VA","zip":"24504-1141","dob":"1969-08-22","age":"","mstatus":"","insh":4488508,"cliId":"","pno":4343168516,"cno":4343168516,"email":"","ename":"","eno":"","pphy":"APONTE, JUAN P","ppno":4349473944,"pcpadd":"2215 Landover Pl, ","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245012115,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"709 NORWOOD STREET","madd2":"                                                            ","madd3":"","mcity":"LYNCHBURG","mstate":"VA","mzip":"24504-1141","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.818","M16.12","R68.89","Z79.01","M25.552","M62.81","R07.89","R79.1","E66.01","E78.5","M54.5","G40.209","R42","R06.02","M54.2","B86","Z01.810","I38","D68.61","Z68.41","D62","I10","G89.18","Z79.899","F17.210","Z88.5","Z82.49","Z83.3","Z80.9","E87.6","F32.9","R56.9","M62.838","M51.37","M79.652","Z96.642","L30.9","L29.9","R07.9","B35.4","I08.0","I27.20","R06.09","F17.200","Z01.811","B37.9","G47.00","M47.816","M47.817","G89.29","Z30.432","L20.9","R07.81","Z87.891","Z98.890","M48.061","M51.27","R21","Z12.4","A59.00","Z11.51","M85.80"],"date":["2019-02-28","2019-05-01","2020-07-23","2020-11-20","2019-08-30","2020-07-23","2020-03-21","2020-03-21","2021-02-10","2021-02-10","2021-02-10","2020-08-27","2020-08-27","2020-09-24","2020-09-24","2020-12-04","2020-01-28","2020-01-28","2020-10-28","2019-05-01","2019-05-01","2021-02-10","2019-05-01","2020-03-21","2021-02-10","2019-05-01","2020-03-21","2019-05-01","2019-05-01","2021-02-10","2020-03-21","2020-08-12","2021-02-10","2021-02-10","2019-05-28","2019-05-28","2020-07-16","2020-04-07","2020-07-16","2020-07-02","2019-01-22","2020-01-28","2020-01-28","2019-01-22","2019-04-02","2020-02-25","2020-02-25","2021-02-10","2020-04-27","2020-04-27","2020-10-06","2020-10-28","2020-10-28","2020-03-21","2020-03-21","2020-04-21","2020-04-21","2020-11-20","2020-10-06","2020-10-06","2020-10-06","2021-02-10"],"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":[["","23155000810","HYDROCHLOROT ","TAB 25MG","90","Select","Select",""],["","68462079817","TRIAMCINOLON ","OIN 0.005","30","Select","Select",""],["","69842048462","ACETAMINOPHN ","TAB 500MG","120","Select","Select",""],["","69918030130","TRANEX ","TAB 650MG","3","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","57664050658","METOPROL ","TAB 25MG","180","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","90","Select","Select",""],["","50742062001","NIFEDIPINE ","TAB 30MG ER","60","Select","Select",""],["","00955100410","ENOXAPARIN ","INJ 40\/0.4ML","3.2","Select","Select",""],["","68180018001","CEFADROXIL ","CAP 500MG","14","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","74312002832","MELATONIN ","TAB 1MG","90","Select","Select",""],["","00093172001","WARFARIN ","TAB 10MG","30","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","200","Select","Select",""],["","50428016183","CVS ","CAP 2000UNIT","30","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","60","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","00904671980","ACETAMINOPHEN ","TA B 325","30","Select","Select",""],["","50111064801","FLUOXETINE ","CAP 20MG","30","Select","Select",""],["","65862022801","LAMOTRIGINE ","TAB 100MG","60","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR ","TAB 5MG","90","Select","Select",""],["","00093321915","KETOCONAZOLE ","CRE 0.02","30","Select","Select",""],["","21922002107","PERMETHRIN ","CRE 0.05","300","Select","Select",""],["","00187137112","CERAVE ","LOT ","355","Select","Select",""],["","59779076678","PAIN ","TAB 325MG","90","Select","Select",""],["","51672126301","NYSTAT\/TRIAM ","CRE ","15","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","15","Select","Select",""],["","60505384901","CELECOXIB ","CAP 200MG","30","Select","Select",""],["","46581083006","SALONPAS ","PAD 0.04","6","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":""}]}]}