{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTINA   W MATHEWS","gend":1,"add":"7765 ARBOR PONDS TERRACE","city":"NEW KENT","state":"VA","zip":"23124-9998","dob":"1983-09-01","age":"","mstatus":"","insh":"900048517*01","cliId":"1F27E84JH66","pno":"804\/617-4939","cno":"804\/617-4939","email":"","ename":"","eno":"","pphy":"NEELY, BRIAN MD","ppno":"804\/306-7073","pcpadd":"611 WATKINS CENTRE PARKWAY SUITE 35","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":23114,"pcpcounty":"","pcpid":199633,"pcpname":"Whole Health Physicians","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"866\/674-0063","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G43.709","M54.5","M54.6","M53.85","E66.9","M25.552","M25.551","M53.84","M53.86","V89.2XXD","Z20.822","M54.50","V49.9XXD","Z74.09","Q79.60","G89.4","M79.7","M46.86","Z72.89","R68.89","Z88.5","Z88.1","Z88.0","Z68.34"],"date":["2021-09-16","2021-09-10","2021-10-07","2021-10-07","2021-10-07","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-09-27","2021-10-07","2021-10-07","2021-10-07","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10"],"priorHcc":[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null]}},{"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":[["","70436001002","BUPROPION HYDROCHLORIDE ER (XL)","150MG XL","30","Select","Select",""],["","59417010610","VYVANSE","60MG","30","Select","Select",""],["","00023650110","UBRELVY","100MG","10","Select","Select",""],["","69680011225","CYANOCOBALAMIN","1000MCG","6","Select","Select",""],["","58160082652","HAVRIX","1440UNIT","1","Select","Select",""],["","00115169449","EPINEPHRINE","0.3MG","2","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","HFA","8","Select","Select",""],["","00378180310","LEVOTHYROXINE SODIUM","50MCG","90","Select","Select",""],["","51862032001","LIOTHYRONINE SODIUM","5MCG","90","Select","Select",""],["","51862056406","LOW-OGESTREL","","84","Select","Select",""],["","59417010610","VYVANSE                                                               ","CAP 60MG","30","Select","Select",""],["","69680011225","CYANOCOBALAMIN                                                        ","INJ 1000MCG","6","Select","Select",""],["","70436001002","BUPROPION HYDROCHLORIDE ER (XL)                                       ","TAB 150MG XL","30","Select","Select",""],["","58160082652","HAVRIX                                                                ","INJ 1440UNIT","1","Select","Select",""],["","00023650110","UBRELVY                                                               ","TAB 100MG","10","Select","Select",""],["","00378180310","LEVOTHYROXINE SODIUM                                                  ","TAB 50MCG","90","Select","Select",""],["","00115169449","EPINEPHRINE                                                           ","INJ 0.3MG","2","Select","Select",""],["","51862032001","LIOTHYRONINE SODIUM                                                   ","TAB 5MCG","90","Select","Select",""],["","51862056406","LOW-OGESTREL                                                          ","TAB ","84","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA                                                 ","AER HFA","8","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","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","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":""}]}]}