{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" DOMINIQUE N GENTRY","gend":1,"add":"2229 Yorktown Ave","city":"Lynchburg","state":"VA","zip":"24501-2156","dob":"1986-10-06","age":"","mstatus":"","insh":7204120,"cliId":"","pno":"7572989837, 7572989837","cno":"","email":"","ename":"","eno":"","pphy":"PRUITT, DAVID E","ppno":"               ","pcpadd":"3510 Anderson Hwy, Ste A","pcpcity":"Powhatan","pcpstate":"VA","pcpzip":231395846,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"WESTERN","aligned":"","ano":"","add2":"Apt 101","add3":"","madd1":"2229 Yorktown Ave","madd2":"Apt 101","madd3":"","mcity":"Lynchburg","mstate":"VA","mzip":"24501-2156","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K08.89","F17.210","R06.89","R52","R68.89","F14.99","F31.5","Z00.01","R14.3","K59.00","F43.10","T42.6X6A","F19.10","D57.3","F31.9","F20.9","Z91.138","Z79.899","Y92.89","N76.0","R12","Z11.3","F41.9","F32.9","F14.10","R10.13","L29.9","T78.40XA","Z23","A59.01","F22","R45.851","N39.0","Z98.51","N99.89","M54.5","Z76.0","Z30.40","R22.32","F43.12","F23","R53.1","R74.0","E80.6","F31.32","Z72.0","I95.9","B00.1","A60.04","R45.7","N89.9","F31.64","E80.7","Z83.2","F14.20","Z56.0","Z91.410","K04.7","F31.4","Z91.14","R53.81","Z30.09","Z30.013","R09.89"],"date":["2020-05-17","2021-05-05","2020-11-25","2020-05-17","2020-05-28","2020-06-30","2021-04-19","2020-08-14","2021-02-27","2020-08-14","2020-12-09","2020-12-09","2021-05-05","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2021-05-14","2021-05-14","2021-02-17","2020-06-25","2021-05-05","2020-07-02","2020-07-02","2020-09-08","2020-09-08","2020-09-08","2021-01-04","2020-06-26","2020-06-26","2021-04-11","2020-02-29","2019-08-13","2020-07-02","2021-03-10","2019-02-06","2019-05-07","2019-05-07","2019-11-18","2019-11-15","2019-11-18","2019-11-18","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-07-08","2020-12-09","2021-02-27","2019-11-18","2019-11-15","2019-11-15","2020-08-20","2020-02-29","2020-06-25","2020-05-17","2020-06-25","2020-06-25","2020-11-25","2019-05-14","2019-05-14","2020-12-09"],"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":[["","69097083412","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","66993068230","OLANZAPINE ","TAB 7.5MG","30","Select","Select",""],["","31722070530","VALACYCLOVIR ","TAB 1GM","30","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","120","Select","Select",""],["","51672300302","HYDROCORT ","CRE 0.025","28.35","Select","Select",""],["","50428056283","GAS ","CAP 180MG","14","Select","Select",""],["","00093117410","PENICILLN ","TAB 500MG","40","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","10","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","5","Select","Select",""],["","59779030603","CVS ","POW ","510","Select","Select",""],["","43547030403","ARIPIPRAZOLE ","TAB 10MG","30","Select","Select",""],["","55111053401","DIVALPROEX ","TAB 500MG ER","90","Select","Select",""],["","59779001951","ALLERGY ","CAP 25MG","12","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","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}