{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DESTINY   P JOHSNON","gend":1,"add":"2002 ACCOMMODATION STREET","city":"RICHMOND","state":"VA","zip":"23223-4218","dob":"1985-05-26","age":"","mstatus":"","insh":7100764,"cliId":"","pno":8044640267,"cno":8044640267,"email":"","ename":"","eno":"","pphy":"BROOKS-WILLIAMS, MALINDA","ppno":8047800840,"pcpadd":"4730 N Southside Plaza St, ","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232241742,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"2002 ACCOMMODATION STREET","madd2":"                                                            ","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23223-4218","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.31","R60.0","M54.2","R22.41","R22.42","R06.02","R07.9","M79.642","R07.89","E66.01","I50.9","I11.0","G47.33","J45.909","Z91.14","M54.12","R73.03","Z79.1","Z79.51","M79.89","E87.6","Z23","G47.00","E04.1","Z76.5","Z68.43","M25.511","S16.9XXA","F11.20","I10","Z79.899","G89.29","M79.671","F10.21","M77.50","M25.371","M25.372","M79.673","M21.6X1","M21.6X2","M79.609","M25.571","M25.572","R26.2","M77.9","J45.21","J02.9","R51","R60.1","Z76.0","M79.604","M79.605","K08.89","N30.00","N89.8","R30.0","Z20.2","N76.0","B96.89","M17.0","F32.9","F25.1","E11.9","M19.90","Z88.5","S60.222A","X58.XXXA","R06.00","R06.2","F10.20","K92.0","Z11.4","Z11.59","Z11.1","R07.0","F41.9"],"date":["2019-05-31","2020-07-12","2019-04-27","2019-03-20","2019-03-20","2020-07-12","2020-04-25","2020-03-16","2020-04-25","2021-03-24","2020-09-09","2020-09-09","2021-03-24","2021-03-24","2020-04-25","2020-04-25","2020-07-12","2021-03-24","2020-04-25","2020-06-08","2020-06-08","2021-05-14","2019-02-11","2019-05-14","2019-04-27","2020-09-09","2019-03-13","2019-03-20","2021-04-29","2021-03-24","2021-03-24","2019-03-27","2019-03-19","2019-03-19","2019-03-27","2019-03-27","2019-03-27","2019-03-27","2019-03-27","2019-03-27","2019-03-27","2019-03-27","2019-03-27","2019-03-27","2019-03-27","2020-03-31","2020-03-31","2020-03-31","2020-09-09","2020-09-09","2019-04-24","2019-04-24","2020-04-10","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2019-02-01","2019-03-20","2019-03-20","2019-03-20","2020-03-16","2020-03-16","2020-03-31","2020-03-31","2019-02-08","2019-04-07","2020-05-18","2020-05-18","2020-05-18","2019-03-06","2019-03-06"],"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":[["","69315011710","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","14","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","67877024910","QUETIAPINE ","TAB 50MG","30","Select","Select",""],["","16729018317","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","76385010401","BENZTROPINE ","TAB 1MG","30","Select","Select",""],["","63304069205","CLINDAMYCIN ","CAP 150MG","40","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","6","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","15","Select","Select",""],["","60505004101","ETODOLAC ","TAB 400MG","60","Select","Select",""],["","71930001912","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","00781502207","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","70010077001","METHOCARBAM ","TAB 750MG","30","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","12","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","51672126302","NYSTAT\/TRIAM ","CRE ","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":""}]}]}