{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EDMONIA   L JONES","gend":1,"add":"1019 BARLEN DRIVE","city":"RICHMOND","state":"VA","zip":"23225-7307","dob":"1990-08-22","age":"","mstatus":"","insh":5711986,"cliId":"","pno":8049392094,"cno":8046830122,"email":"","ename":"","eno":"","pphy":"ROTHEMICH, STEPHEN F","ppno":8048285883,"pcpadd":"401 N 11th St, ","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232191901,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":8043250569,"add2":"                                                            ","add3":"","madd1":"1019 BARLEN DRIVE","madd2":"                                                            ","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23225-7307","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K43.6","R68.89","N39.0","J11.1","Z11.3","Z12.4","Z11.51","B37.3","N89.8","L73.2","F17.200","Z79.3","Z79.899","R51","M54.2","F31.30","F31.4","R07.9","F41.9","F31.32","H57.9","S93.402A","Y93.89","J02.9","F17.210","Z71.6","E66.9","Z68.42","Z87.442","Z01.419","Z32.01","Z87.59","F31.81","S40.212A","S20.212A","F32.9","R45.851","X58.XXXA","R05","F25.0","G47.33","E66.01","M54.9","O23.41","O26.891","R10.2","Z3A.01","O99.211","O10.911","O99.331","Z33.1","Z68.43","O09.211","O09.291","Z3A.12","O09.212","O09.292","O99.212","Z3A.16","S40.022A","M79.622","R10.9","Y04.0XXA","Y92.89","F31.89","F43.10","Z87.19","Z91.040","Z91.018","J45.909","Z91.14","T43.592A","R45.850","M54.5","R30.0","R10.30","N76.0","B96.89","F31.9","O36.80X0","N92.6","F43.12","S05.02XA","H57.89","I77.1","K42.9","K43.9","Z30.42","H92.03","Z11.4","Z13.9","M25.572","R11.0","Z71.3","Z32.02","R07.2","I49.49","Z04.89","J45.901","R06.83","N91.2","Z30.013","I10","X50.1XXA","R06.02","O99.511","Z87.891","Z34.82","N20.0","Z68.41","Z98.890"],"date":["2019-01-08","2019-01-21","2021-01-08","2019-03-19","2020-07-22","2019-04-01","2019-04-01","2019-09-17","2019-12-17","2019-06-25","2021-02-23","2019-06-25","2021-02-23","2020-01-09","2019-08-04","2020-04-23","2021-01-06","2019-11-13","2020-09-20","2020-04-27","2020-09-13","2020-09-20","2020-09-20","2020-10-08","2021-03-08","2020-10-08","2021-05-11","2021-02-23","2020-10-08","2021-03-09","2021-03-09","2021-03-09","2019-03-03","2019-04-14","2019-04-14","2020-04-23","2020-04-24","2020-09-13","2020-04-23","2020-10-05","2020-05-27","2021-03-08","2021-01-08","2021-03-03","2021-03-03","2021-03-03","2021-03-08","2021-04-13","2021-03-08","2021-03-08","2021-03-08","2021-05-11","2021-04-13","2021-04-13","2021-04-13","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2019-04-14","2019-04-14","2021-03-03","2019-04-14","2019-04-14","2019-04-14","2020-04-23","2019-04-14","2019-04-14","2020-04-23","2021-03-03","2020-04-23","2020-04-23","2020-04-23","2021-02-23","2021-01-01","2021-01-01","2021-01-01","2021-01-01","2021-02-23","2021-03-12","2020-05-15","2019-04-18","2020-09-13","2020-09-13","2021-03-03","2019-01-08","2019-01-21","2019-12-17","2019-08-04","2020-05-15","2020-05-15","2020-09-20","2021-02-23","2019-02-20","2019-12-17","2019-11-13","2020-04-24","2019-04-14","2020-01-09","2020-01-09","2020-07-22","2020-07-22","2020-07-22","2020-09-20","2021-03-03","2021-03-03","2021-03-03","2021-05-11","2019-01-08","2019-01-08","2019-01-21"],"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":[["","59762453702","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","55111014512","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","29300011101","LAMOTRIGINE ","TAB 25MG","70","Select","Select",""],["","13668021730","ARIPIPRAZOLE ","TAB 5MG","30","Select","Select",""],["","65862001905","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","50111043302","TRAZODONE ","TAB 50MG","60","Select","Select",""],["","00363010412","PAIN ","TAB 325MG","24","Select","Select",""],["","63402030630","LATUDA ","TAB 60MG","30","Select","Select",""],["","00115180401","HYDROXYZ ","CAP 50MG","60","Select","Select",""],["","11523716202","CLARITIN-D ","TAB 5-120MG","20","Select","Select",""],["","39328010610","PRENATAL ","TAB 27-1MG","30","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","24208091055","ERYTHROMYCIN ","OIN OP","3.5","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","00536440601","VITAMIN ","TAB 25MG","56","Select","Select",""],["","00363048630",""," ","5","Select","Select",""],["","00406324301","HYDROMORPHON ","TAB 2MG","12","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","00904645760","DOK ","CAP 100MG","10","Select","Select",""],["","55111017915","TIZANIDINE ","TAB 2MG","15","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","12843053642","BAYER ","TAB 81MG EC","90","Select","Select",""],["","27241009803","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","20","Select","Select",""],["","00591336905","BUT\/APAP\/CAF ","TAB ","15","Select","Select",""],["","00591544310","PREDNISONE ","TAB 20MG","19","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":""}]}]}