{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRIANNA   Z BANKS","gend":1,"add":"302 ENGLESIDE DRIVE","city":"RICHMOND","state":"VA","zip":"23222-1632","dob":"1997-05-17","age":"","mstatus":"","insh":6471000,"cliId":"","pno":8049863444,"cno":8048825084,"email":"","ename":"","eno":"","pphy":"GREEN, HAROLD T","ppno":8046441665,"pcpadd":"2421 Chamberlayne Ave, ","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232224205,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":8048825084,"add2":"APT 1D","add3":"","madd1":"302 ENGLESIDE DRIVE","madd2":"APT 1D","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23222-1632","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.31","A80.0","B37.3","Z20.2","J06.9","R05","J20.9","B97.89","K08.89","Z71.1","R51.9","V89.2XXA","M54.2","J02.9","H10.9","A60.00","N89.8","F17.210","Z79.899","F32.9","S63.612A","M79.89","S69.91XA","M79.644","Y04.0XXA","S61.252A","L02.214","L98.8","A59.01","R30.0","Z32.02","Z88.6","Z51.89","Z48.00","F39","N93.9","Z30.46","F33.3","Y93.89","N39.0","L02.31","R21","N76.0","B96.89","F33.2","S16.1XXA","V49.50XA","V87.7XXA","B20","G47.9","A59.9"],"date":["2021-02-21","2019-02-08","2019-10-11","2020-01-06","2019-12-10","2019-12-10","2019-12-10","2019-12-10","2020-01-06","2020-01-06","2020-10-11","2020-10-11","2020-10-11","2019-01-13","2019-01-13","2019-02-08","2020-09-30","2021-04-14","2021-04-12","2020-11-12","2019-05-02","2019-05-02","2019-05-02","2019-05-02","2019-05-02","2019-05-02","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2021-04-14","2021-04-14","2020-08-27","2019-05-02","2019-06-21","2020-07-05","2019-05-02","2019-10-11","2021-04-12","2021-04-12","2019-01-13","2019-01-13","2020-09-13","2020-10-11","2020-10-11","2020-10-11","2020-11-12","2020-04-14","2020-09-30"],"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":[["","50111033402","METRONIDAZOL ","TAB 500MG","4","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","10","Select","Select",""],["","49884072703","DOXYCYC ","CAP 100MG","14","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","15","Select","Select",""],["","49702022813","TIVICAY ","TAB 50MG","30","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","68382079101","ACYCLOVIR ","TAB 400MG","21","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","13107003134","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","00378334053","XULANE ","DIS 150-35","3","Select","Select",""],["","69097084705","ESCITALOPRAM ","TAB 5MG","30","Select","Select",""],["","17478007031","ERYTHROMYCIN ","OIN OP","4","Select","Select",""],["","00406012405","HYDROCO\/APAP ","TAB 7.5-325","14","Select","Select",""],["","65862069790","VENLAFAXINE ","CAP 150MG ER","30","Select","Select",""],["","65862001705","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","59676080030","SYMTUZA ","TAB ","30","Select","Select",""],["","60432060416","PROMETHAZINE ","SYP DM","180","Select","Select",""],["","00363010412","PAIN ","TAB 325MG","20","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00406048410","APAP\/CODEINE ","TAB 300-30MG","16","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","00115180301","HYDROXYZ ","CAP 25MG","60","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","40","Select","Select",""],["","57237004105","PENICILLN ","TAB 500MG","28","Select","Select",""],["","53489012002","DOXYCYCL ","100MG","20","Select","Select",""],["","45802073684","CLINDAMY\/BEN ","1.2-5%","45","Select","Select",""],["","00168042446","ADAPALENE ","0.10%","45","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":""}]}]}