{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THOMAS BEASLEY","gend":0,"add":"521 CEDAR LEVEL ROAD","city":"HOPEWELL","state":"VA","zip":"23860-4159","dob":"2002-10-01","age":"","mstatus":"","insh":6902010,"cliId":"","pno":8042953148,"cno":8042953148,"email":"","ename":"","eno":"","pphy":"YU, LANPING","ppno":8045183288,"pcpadd":"325 Charles H Dimmock Pkwy, Ste 600","pcpcity":"Colonial Heights","pcpstate":"VA","pcpzip":238342988,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"521 CEDAR LEVEL ROAD","madd2":"                                                            ","madd3":"","mcity":"HOPEWELL","mstate":"VA","mzip":"23860-4159","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05","R50.9","J02.9","J06.9","S81.011A","S60.511A","M25.571","M25.471","S93.491A","S81.821A","Z48.02","J45.909","S63.501A","M79.641","W13.2XXA","F17.200","F31.9","M19.012","M25.711","M25.712","M25.511","M25.512","R07.9","K21.9","M79.89","S99.911A","T78.40XA","R21","I49.8","R07.89","F31.32","M25.561","S81.021D","L08.9","R51","S63.502A","W18.30XA","M54.9","I10","S60.221A","Y04.0XXA","S29.9XXA","R07.81","M25.532","M79.632","V86.56XA","S59.912A","S69.92XA","R06.02","R09.81","L70.8","Z23","S69.91XA","S09.8XXA","W22.8XXA","S09.90XA","R51.9","W22.09XA","R40.2142","R40.2362","R40.2252","L29.9","L70.0","R07.2","F39","R45.851","R10.13","R10.10","Z00.121","E66.9","Z13.89","R11.10","B97.89","M79.10","R10.33","T63.461A","M79.672","R22.42","T63.481A","L20.9","S89.91XA","W17.89XA","S93.401A","Z20.828","F41.9"],"date":["2019-08-10","2019-08-10","2019-12-31","2020-10-06","2020-01-13","2020-01-13","2020-01-13","2020-01-13","2020-01-14","2020-01-14","2020-01-28","2020-09-20","2020-12-03","2021-01-03","2020-12-03","2020-12-03","2020-12-05","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2020-11-17","2020-08-18","2020-01-13","2020-01-13","2020-07-30","2020-07-30","2020-11-17","2020-11-17","2020-12-09","2020-01-21","2020-01-21","2020-01-21","2020-09-26","2020-12-03","2020-12-03","2020-08-18","2020-09-26","2021-01-03","2021-01-03","2021-01-31","2021-01-31","2021-01-31","2021-01-31","2021-01-31","2021-01-31","2021-01-31","2019-08-09","2019-08-09","2019-10-25","2020-09-04","2021-01-03","2021-02-20","2021-02-20","2021-02-20","2021-02-20","2021-02-20","2021-02-20","2021-02-20","2021-02-20","2020-07-30","2020-08-18","2020-11-16","2020-12-03","2020-12-05","2019-09-19","2020-03-12","2020-09-04","2020-09-04","2020-09-04","2019-02-11","2019-02-11","2019-02-11","2019-02-11","2019-10-06","2019-10-06","2019-10-06","2019-10-06","2019-11-18","2020-01-13","2020-01-13","2020-01-13","2020-12-03","2020-12-03"],"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":[["","65162003310","APAP\/CODEINE ","TAB 300-30MG","20","Select","Select",""],["","45802006535","TRIAMCINOLON ","CRE 0.005","45","Select","Select",""],["","67877021901","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","59762374401","CLINDAMYCIN ","LOT 10MG\/ML","60","Select","Select",""],["","64380071206","BENZONATATE ","CAP 100MG","20","Select","Select",""],["","55111015901","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","00536105556","ACNE ","GEL 0.05","42.5","Select","Select",""],["","65162046650","IBUPROFEN ","TAB 800MG","21","Select","Select",""],["","64679096105","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","52565003330","ERYTHROMYCIN ","GEL 0.02","30","Select","Select",""],["","68382080501","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","16571020210","DICLOFENAC ","TAB 50MG DR","20","Select","Select",""],["","69097012303","TOPIRAMATE ","TAB 50MG","60","Select","Select",""],["","00904672080","ACETAMIN ","TAB 500MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","17","Select","Select",""],["","65862052201","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","59746017506","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","00172572960","FAMOTIDINE ","TAB 40MG","5","Select","Select",""],["","11026278004","BRONCOTRON ","LIQ PED","150","Select","Select",""],["","65862039110","ONDANSETRON ","TAB 8MG ODT","9","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":""}]}]}