{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTHONY VENTURA","gend":0,"add":"4000 PEREGRINE ROAD","city":"NORTH CHESTERFIEL","state":"VA","zip":"23237-4343","dob":"1973-10-31","age":"","mstatus":"","insh":5072542,"cliId":"","pno":8048885886,"cno":8048885886,"email":"","ename":"","eno":"","pphy":"BECKWITH, DOUGLAS E","ppno":8047962373,"pcpadd":"12901 Briggs Rd, ","pcpcity":"Chester","pcpstate":"VA","pcpzip":238315335,"pcpcounty":"","pcpid":"","pcpname":"SOUTHSIDE PHYSICIANS NETWORK-F","ano":"","add2":"                                                            ","add3":"","madd1":"4000 PEREGRINE ROAD","madd2":"                                                            ","madd3":"","mcity":"NORTH CHESTERFIEL","mstate":"VA","mzip":"23237-4343","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M22.42","X58.XXXA","S80.02XA","E11.9","I10","Z01.818","Z98.84","G56.01","G56.21","M19.012","R07.9","S46.012A","S89.92XA","W22.8XXA","Z79.84","Z79.82","M25.552","M25.551","M54.5","Z96.641","Z47.1","E11.65","J00","M17.9","Z68.42","M17.12","E55.9","E78.2","G47.33","Z68.41","E66.01","L03.116","A41.9","M19.90","E78.5","M25.562","S22.080A","M19.031","M22.41","M19.011","G56.02","G89.18","M54.6","G89.29","N52.9","M23.322","M23.8X2","S83.202A","M94.262","L02.416","L03.115","L02.211","Z96.611","B95.62","Z79.899","Z79.891","Z79.4","Z79.01","Z98.890","Z91.81","R73.9","E66.9","E29.1","G47.30","D63.8","M11.262","Z13.89","M25.559","E11.8","E78.00","M75.41","S43.421A","M75.42","R10.9","R06.02","R63.5","M79.89","R20.9","M17.0","M25.569"],"date":["2020-10-26","2019-09-06","2019-09-06","2021-04-08","2021-04-08","2020-02-19","2021-03-04","2020-09-15","2020-09-08","2021-03-03","2019-01-14","2019-01-14","2019-04-22","2019-04-22","2019-04-22","2021-01-08","2019-09-17","2019-09-17","2019-09-17","2019-09-17","2019-09-17","2021-03-10","2020-01-23","2020-01-23","2020-02-20","2021-03-25","2021-03-10","2021-03-10","2021-03-04","2021-03-25","2021-03-25","2019-01-28","2019-01-28","2019-02-01","2020-12-03","2020-10-26","2019-07-07","2020-05-05","2019-08-26","2020-12-30","2020-11-17","2020-11-17","2021-02-05","2021-04-08","2021-04-08","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2019-01-24","2019-09-05","2019-12-07","2019-01-26","2019-01-26","2019-01-26","2019-01-26","2020-02-10","2019-01-26","2019-01-26","2019-01-26","2019-01-14","2019-01-14","2019-05-09","2020-02-10","2019-07-16","2019-09-06","2019-09-06","2019-09-17","2020-02-10","2020-02-10","2019-01-14","2019-01-14","2019-01-14","2019-12-07","2019-04-16","2019-04-16","2019-09-05","2020-08-13","2021-03-08","2021-04-08"],"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":[["","68645057454","GLIPIZIDE ","TAB 5MG","90","Select","Select",""],["","68645058259","METFORMIN ","TAB 500MG","180","Select","Select",""],["","00591288401","VERAPAMIL ","CAP 240MG SR","90","Select","Select",""],["","68645055554","LISINOPRIL ","TAB 40MG","90","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","28","Select","Select",""],["","00169413602","OZEMPIC ","INJ 2\/1.5ML","3","Select","Select",""],["","68645056854","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","68645019159","METOPROL ","TAB 100MG","30","Select","Select",""],["","68645055854","LISINOP\/HCTZ ","TAB 20-25MG","30","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","99073012050","FREESTYLE    TES","TES ","50","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","6","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","30","Select","Select",""],["","33342006510","VALSARTAN ","TAB 320MG","30","Select","Select",""],["","53885014301","ONETOUCH ","MIS LANCETS","25","Select","Select",""],["","00169406013","VICTOZA ","INJ 18MG\/3ML","9","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","10","Select","Select",""],["","68645051054","HYDROCHLOROT ","TAB 25MG","90","Select","Select",""],["","53489012002","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","68462018022","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","59746017710","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","60505265605","TRIAMT\/HCTZ ","TAB 37.5-25","30","Select","Select",""],["","69543038810","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","50383077504","LIDOCAINE ","2% VISC","100","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}