{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HARVEY   W ARBOGAST","gend":0,"add":"90 CURLEY LANE","city":"COLONIAL BEACH","state":"VA","zip":"22443-9998","dob":"1976-07-09","age":"","mstatus":"","insh":4580526,"cliId":"","pno":5409403230,"cno":5409403230,"email":"","ename":"","eno":"","pphy":"PERRAUT, MICHAEL EDWARD","ppno":5402892273,"pcpadd":"2565 Cowan Blvd, ","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224018440,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"APT A","add3":"","madd1":"90 CURLEY LANE","madd2":"APT A","madd3":"","mcity":"COLONIAL BEACH","mstate":"VA","mzip":"22443-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L40.9","D12.4","Z93.3","Z87.898","Z43.3","R10.9","J18.1","K57.92","A41.9","F10.10","R03.0","F17.200","K56.699","Z93.2","K63.89","K56.609","Z90.49","Z98.890","S31.109D","Z43.2","S09.90XA","S01.01XA","G31.9","X58.XXXA","Y92.89","Y93.89","Z13.39","R45.851","Y90.8","E87.6","I10","F17.210","I49.8","F32.9","F15.10","Z11.59","F33.2","F10.20","K57.20","K57.32","J20.9","R05","Z98.0","G89.18","Z48.815","K76.0","J00","R07.0","J02.9","H61.20","R58","R52","R00.0","K57.90","R68.89","K55.9","F10.231","Z87.891","R10.31","R51.9","R22.0","Z00.01","Z01.89","Z71.89","Z13.31","F41.9","G47.00","Z01.818","D64.9","R78.81","F10.239","K63.5","K57.31","Z87.19","T81.89XA","Z71.2","Z71.3","K57.30","R10.30","L92.9","R10.84","R11.2","Z01.812","Z78.9","Y90.9","K56.7","L03.311","G89.29","S93.409A","S36.893A","K43.2","K91.89","Z76.0","L40.8","Z01.810","R94.31","Z13.6","S01.91XA","W22.8XXA"],"date":["2019-04-02","2019-04-02","2020-10-20","2019-04-02","2019-05-03","2020-10-20","2019-05-04","2020-01-08","2019-05-04","2021-02-25","2019-08-16","2019-05-04","2019-07-10","2020-01-07","2019-08-02","2019-08-09","2019-08-01","2020-01-24","2019-08-01","2020-02-14","2020-12-25","2020-12-25","2020-12-25","2020-12-25","2020-12-25","2020-12-25","2020-12-28","2020-12-31","2020-12-28","2020-12-30","2020-12-28","2020-12-28","2020-12-30","2020-12-30","2020-12-30","2020-12-30","2021-01-18","2021-02-22","2019-05-03","2019-05-03","2019-12-04","2019-12-04","2020-01-07","2020-01-09","2020-02-14","2020-10-20","2020-11-30","2020-11-30","2020-11-30","2020-11-28","2020-12-25","2020-12-25","2020-12-25","2019-02-11","2021-02-22","2019-05-03","2019-08-25","2019-08-23","2020-10-20","2020-12-25","2020-12-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2019-08-22","2019-05-09","2019-05-09","2019-08-23","2019-02-11","2019-02-11","2019-02-11","2019-05-28","2019-09-18","2019-09-18","2019-05-01","2020-01-09","2019-06-12","2019-07-08","2019-07-08","2020-01-07","2019-04-23","2019-05-03","2019-05-03","2019-08-16","2019-05-03","2019-05-03","2019-05-03","2019-05-03","2019-05-03","2019-08-16","2019-08-16","2019-08-22","2019-08-22","2019-09-11","2020-12-25","2020-12-25"],"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":[["","50228017705","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","16714008310","HYDROXYZ ","TAB 50MG","120","Select","Select",""],["","68180044601","QUETIAPINE ","TAB 50MG","135","Select","Select",""],["","29300011616","TOPIRAMATE ","TAB 50MG","30","Select","Select",""],["","00093406701","PRAZOSIN ","CAP 1MG","30","Select","Select",""],["","00406117003","NALTREXONE ","TAB 50MG","60","Select","Select",""],["","68645052354","SERTRALINE ","TAB 100MG","60","Select","Select",""],["","67877025130","TRIAMCINOLON ","CRE 0.001","30","Select","Select",""],["","68645055254","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","49035002810","MAG ","SOL GRAPE","296","Select","Select",""],["","00234057504","HIBICLENS ","LIQ 0.04","118","Select","Select",""],["","00591544310","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","68382080601","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","00168026815","AUG ","OIN 0.0005","45","Select","Select",""],["","50428028552","ACETAMINOPHN ","TAB 500MG","30","Select","Select",""],["","00555015902","CHLORDIAZEP ","CAP 25MG","30","Select","Select",""],["","51672127401","BETAMETH ","CRE 0.0005","45","Select","Select",""],["","55111029209","SUMATRIPTAN ","TAB 50MG","9","Select","Select",""],["","00132020142","FLEET ","ENE ","2","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","67877031901","IBUPROFEN ","TAB 400MG","30","Select","Select",""],["","00781572001","POT  CL MICRO","TAB 20MEQ ER","15","Select","Select",""],["","00832059011","DIPHEN\/ATROP ","TAB ","14","Select","Select",""],["","00406324301","HYDROMORPHON ","TAB 2MG","28","Select","Select",""],["","43386009019","GAVILYTE-G ","SOL ","4,000.00","Select","Select",""],["","12830082430","EZFE ","CAP 200MG","60","Select","Select",""],["","10572010001","PEG-3350 ","SOL ELECTROL","4,000.00","Select","Select",""],["","00005446119","CENTRUM ","CHW SILVER","30","Select","Select",""],["","00591079021","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","69452014320","BENZONATATE ","CAP 100MG","27","Select","Select",""],["","45802043805","HYDROCORT ","CRE 0.01","30","Select","Select",""],["","57664037718","TRAMADOL ","TAB 50MG","20","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","42858000101","OXYCODONE ","TAB 5MG","10","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":""}]}]}