{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NASIRAH MITCHELL","gend":1,"add":"2311 DUBLIN STREET","city":"HOPEWELL","state":"VA","zip":"23860-6214","dob":"1972-10-08","age":"","mstatus":"","insh":7927284,"cliId":"","pno":9085765061,"cno":9085765061,"email":"","ename":"","eno":"","pphy":"GADANI, MANU R","ppno":8044582006,"pcpadd":"5303 Plaza Dr, Ste 101","pcpcity":"Hopewell","pcpstate":"VA","pcpzip":238607331,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"APT B","add3":"","madd1":"2311 DUBLIN STREET","madd2":"APT B","madd3":"","mcity":"HOPEWELL","mstate":"VA","mzip":"23860-6214","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R25.2","E16.2","M79.604","M79.605","M54.2","M47.812","R20.0","M25.532","R68.89","L60.8","L98.9","L65.9","N17.9","R41.82","R79.89","R74.0","R41.0","R00.0","R94.31","N60.02","N63.10","N63.20","N60.01","M25.512","M51.37","S09.8XXA","S00.83XA","I61.8","D57.3","K72.00","R94.5","M62.82","I42.2","R93.2","F14.90","M25.551","M25.552","A48.0","D72.829","K76.89","I21.A1","N39.0","B96.20","B37.0","B95.61","R60.9","M79.651","M79.652","F41.9","F33.0","R06.00","T50.904A","T40.601A","T79.6XXD","M79.606","R94.6","M54.41","Z68.25","M54.5","F14.20","L90.5","H04.129","G43.909","R51","M21.611","M20.41","M21.621","L08.9","R92.8","R79.9","R60.1","F14.10","S36.118A","M62.9","I21.4","F14.120","F32.9","D64.9","L85.1","M47.817","M20.40","Z91.81","Z90.721","Z79.82","N60.11","N60.12","N63.12","M54.16","M79.662","M79.661","R20.2","M54.9","M20.11","Z01.818","Z47.89","G93.40","E87.5","F19.982","F32.89","Z68.22","M46.1","M46.06","M25.78","M51.36","M67.471","M50.30","N89.8","M53.3","N28.1","T40.5X1A","G93.6","G93.41","R57.9","E87.2","I47.2","G93.1","L03.115","L02.31","R26.9","F14.11","K75.9","T79.6XXS","M54.17","M79.669","Z12.39","G56.00","M21.619","Z71.89","Z71.3","W22.01XA","R21","K63.89","R18.8","I21.9","M16.0","M79.9","F33.1","T50.901A","Z01.810","M79.89","R07.89","W22.8XXA","R06.02","H53.8","M65.30","Z12.31","F14.920","M54.42","M48.07","M51.16","Z00.00","Z12.4","N60.09","H11.441","G56.02","R53.83","M50.90","R10.11","Z01.419","N76.2","D57.1","K76.9","N28.9","M60.9"],"date":["2020-12-03","2019-02-16","2019-02-21","2020-12-09","2019-07-25","2020-07-19","2020-10-08","2019-07-25","2021-02-25","2020-01-20","2020-01-20","2020-01-20","2020-07-31","2020-07-19","2020-07-19","2020-07-19","2020-07-19","2020-07-19","2020-07-27","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-12-13","2021-05-10","2019-10-15","2019-10-15","2020-07-20","2020-08-05","2020-07-21","2020-07-20","2020-08-05","2020-07-20","2020-07-20","2020-08-05","2020-12-29","2020-10-08","2020-07-31","2020-07-31","2020-07-31","2020-07-30","2020-07-29","2020-07-29","2020-07-30","2020-07-30","2020-07-30","2020-08-06","2020-12-29","2020-11-06","2020-10-14","2020-11-06","2020-11-06","2020-11-06","2020-12-29","2020-12-29","2021-01-05","2020-12-13","2021-01-05","2021-03-03","2021-03-29","2019-03-14","2019-03-14","2020-08-05","2019-11-30","2019-11-07","2019-11-07","2020-08-05","2020-02-28","2020-03-16","2020-07-20","2020-07-21","2020-07-28","2020-07-28","2020-07-30","2020-10-08","2020-08-05","2020-10-08","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-12-13","2020-09-25","2020-09-25","2020-09-25","2021-05-19","2019-02-21","2019-02-21","2020-11-11","2019-07-25","2019-11-04","2019-11-04","2019-11-18","2020-07-24","2020-07-20","2020-09-09","2020-08-19","2020-12-07","2021-01-08","2021-01-08","2021-01-08","2021-04-09","2019-09-05","2019-09-05","2019-09-05","2020-07-19","2020-07-20","2020-11-06","2020-07-19","2020-07-19","2020-07-19","2020-07-19","2020-07-19","2020-07-19","2020-07-19","2020-07-19","2020-07-31","2020-08-05","2020-08-05","2020-10-08","2020-11-11","2019-02-18","2019-02-18","2019-07-18","2019-10-07","2019-10-07","2019-10-07","2019-10-15","2020-07-14","2020-07-20","2020-07-20","2020-07-27","2020-07-27","2020-07-27","2020-11-06","2020-11-06","2020-12-29","2019-10-21","2019-11-30","2019-11-30","2019-11-30","2019-11-30","2020-03-19","2020-03-05","2020-07-21","2020-12-13","2021-04-09","2021-04-09","2019-01-07","2019-01-07","2019-01-07","2019-03-18","2019-07-18","2020-07-19","2019-07-18","2019-09-13","2020-02-24","2020-02-24","2020-07-19","2020-07-20","2020-07-20","2020-07-21"],"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":[["","16571020110","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","00185067401","HYDROXYZ ","CAP 25MG","90","Select","Select",""],["","69097012303","TOPIRAMATE ","TAB 50MG","30","Select","Select",""],["","69097096507","NABUMETONE ","TAB 500MG","60","Select","Select",""],["","00603254421","BUT\/APAP\/CAF ","TAB ","15","Select","Select",""],["","45802005535","TRIAMCINOLON ","OIN 0.001","15","Select","Select",""],["","57237001830","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR ","TAB 5MG","30","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","30","Select","Select",""],["","13668033101","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","11822316910","RA ","TAB 81MG EC","30","Select","Select",""],["","00406048410","APAP\/CODEINE ","TAB 300-30MG","15","Select","Select",""],["","68382005101","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","50228018005","GABAPENTIN ","CAP 300MG","30","Select","Select",""],["","00591234101","METAXALONE ","TAB 800MG","30","Select","Select",""],["","68462029855","CLOTRIM\/BETA ","CRE DIPROP","45","Select","Select",""],["","42858010301","OXYCOD\/APAP ","TAB 7.5-325","12","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","5","Select","Select",""],["","59746017306","PREDNISONE ","TAB 10MG","30","Select","Select",""],["","72647033104","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","68462019001","NAPROXEN ","TAB 500MG","15","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","13107005501","OXYCODONE ","TAB 5MG","6","Select","Select",""],["","67618012012","SENOKOT ","TAB 17.2MG","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":""}]}]}