{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TWANISHA   L TILLMAN","gend":1,"add":"2316 WHITCOMB STREET","city":"RICHMOND","state":"VA","zip":"23223-3852","dob":"1995-10-15","age":"","mstatus":"","insh":6396900,"cliId":"","pno":8042482632,"cno":8045280621,"email":"","ename":"","eno":"","pphy":"JENNINGS, TORINO R","ppno":8047800840,"pcpadd":"2025 E Main St, Ste 7","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232237069,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":8045280621,"add2":"                                                            ","add3":"","madd1":"2316 WHITCOMB STREET","madd2":"                                                            ","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23223-3852","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O23.592","R10.9","B96.89","O98.812","B37.9","O99.332","F17.210","Z3A.16","O26.892","R10.13","N76.0","O99.212","Z3A.19","O26.893","O26.899","M54.5","Z3A.38","O24.419","Z87.891","L22","Q75.9","O24.410","Z3A.21","O99.613","K21.9","Z3A.35","Z79.84","R10.84","J06.9","J02.9","R51.9","R09.81","R05","Z20.828","N89.8","O26.92","R03.0","R80.9","Z79.82","Z79.899","Z23","Z3A.32","O24.415","Z3A.36","R11.2","E88.81","E66.9","Z68.42","O24.429","Z3A.39","O99.214","O99.824","Z79.1","Z37.0","Z91.19","Z36.2","O99.213","Z3A.28","F17.200","Z79.3","M79.10","Z34.02","Z3A.34","O99.89","O98.311","A74.9","Z3A.10","Z34.01","O16.2","Z3A.23","E66.01","M54.89","O80","Z3A.00","E11.9"],"date":["2019-07-16","2019-12-24","2019-07-16","2019-07-16","2019-07-16","2019-07-16","2019-08-07","2019-07-16","2019-08-07","2019-11-30","2019-07-16","2019-09-13","2019-08-16","2019-12-24","2019-12-24","2019-12-24","2019-12-24","2019-12-24","2019-12-26","2020-01-09","2020-01-09","2019-12-24","2019-10-30","2019-11-30","2020-12-11","2019-11-30","2019-12-26","2019-11-30","2020-12-11","2020-12-11","2020-12-11","2020-12-11","2021-01-20","2021-01-20","2019-08-07","2019-08-07","2019-08-07","2019-08-07","2019-12-26","2019-08-07","2019-10-16","2019-11-13","2019-11-30","2019-12-11","2019-12-04","2019-12-11","2020-12-11","2019-12-11","2019-12-27","2019-12-27","2019-12-26","2019-12-27","2019-12-26","2019-12-27","2019-12-26","2019-10-11","2019-10-11","2019-10-11","2020-12-11","2020-12-11","2021-01-20","2019-11-22","2019-11-27","2019-12-24","2019-06-05","2019-06-05","2019-06-05","2019-06-26","2019-08-08","2019-09-13","2019-12-27","2019-12-24","2019-12-27","2019-12-27","2019-12-27"],"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":[["","00555901658","SPRINTEC ","TAB 28 DAY","28","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","40","Select","Select",""],["","70700011985","ESTARYLLA ","TAB 0.25-35","28","Select","Select",""],["","00781707787","METRONIDAZOL ","GEL 0.75%VAG","70","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","69543025810","PREPLUS ","TAB 27-1MG","30","Select","Select",""],["","51224000760","METFORMIN ","TAB 500MG ER","60","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","68382004001","PROMETHAZINE ","TAB 12.5MG","20","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","40","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","00054001925","PREDNISONE ","TAB 50MG","3","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":""}]}]}