{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NEVETSYTIROD","gend":0,"add":"tidarT 6098  rD lanoi","city":"Henrico  ","state":"VA","zip":"23294-6110","dob":"1952-10-16","age":"","mstatus":"","insh":"10111680","cliId":"1EQ7RN8TA41","pno":"7240806160","cno":8042706160,"email":"","ename":"","eno":"","pphy":"RACKSON, KATHRYN  ","ppno":8042543500,"pcpadd":"2116 W Laburnum Ave Ste 100","pcpcity":"Richmond ","pcpstate":"VA","pcpzip":232274359,"pcpcounty":"Richmond City","pcpid":"P0060414","pcpname":"VCU CENTER FOR ADVANCED HEALTH","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"8906 Traditional Dr  ","madd2":"","madd3":"","mcity":"Henrico  ","mstate":"VA","mzip":"23294-6110","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M46.36","Z79.01","A40.9","M46.44","M54.9","M19.90","G89.29","E87.1","K70.30","F10.10","I10","Z51.81","Z79.2","A41.9","M46.40","R78.81","B95.5","K74.60","K76.6","R16.1","R18.8","K76.0","M47.817","I25.10","N20.0","N40.0","R10.9","M54.5","B35.1","M79.673","M20.42","M20.21","M20.22","K70.9","F10.21","Z79.899","R93.6","T84.213D","Z98.1","M19.072","M21.272","F10.20","I81","R10.32","M46.46","R05","R42","R93.41","R19.7","M47.816","Z87.39","R35.8","Z86.59","K52.9","R09.81","H91.91","M20.20","H74.8X1","Z96.22","Z01.818","Z11.59","M20.12","F17.210","F14.11","Z79.51","Z86.718","M20.5X2","M21.612","M79.89","Z47.89","L57.0","L60.2","B35.3","L82.1","L81.4","L24.9","L57.8","X32.XXXD","L72.0","Z85.828","M79.672","S92.312D","S92.532D","Z09","Z23","Z20.828","K29.50","B96.81","K29.70","K31.89","I85.10","H61.23","H90.3","M19.211","M25.511","T84.89XD","F10.182","K70.31","M20.40","M15.9","H81.399","H53.8","R09.3","Z87.81","Z86.19","Z68.29","M77.32","I85.00","M75.101","M19.011","I67.82","J34.1","M79.671","H25.13","H25.12","H25.11","H26.9","K76.9","H43.813","R10.84","K42.9","Z68.28"],"date":["2020-01-11","2020-01-02","2020-01-22","2020-01-13","2020-03-17","2020-08-04","2020-08-04","2020-03-16","2021-07-28","2021-07-14","2020-07-16","2020-01-08","2020-01-08","2020-01-16","2020-03-05","2020-04-23","2020-03-16","2021-07-28","2020-12-03","2021-07-28","2020-01-21","2020-01-21","2020-01-21","2020-01-21","2020-01-21","2020-04-23","2020-04-23","2020-03-17","2020-02-13","2020-08-13","2020-08-04","2020-02-13","2020-08-04","2021-05-20","2020-02-13","2021-07-14","2020-02-13","2020-02-13","2021-03-11","2020-09-15","2020-09-01","2020-08-04","2021-02-03","2020-03-16","2020-08-04","2020-07-16","2021-08-11","2020-03-16","2020-06-18","2020-03-17","2020-03-17","2020-05-05","2021-02-03","2020-05-05","2020-06-18","2020-06-18","2020-07-31","2020-07-29","2021-01-13","2020-11-30","2020-11-30","2020-08-04","2021-08-11","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2020-10-21","2021-01-26","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-09-01","2020-09-15","2020-09-15","2020-10-21","2020-10-16","2020-11-12","2020-12-03","2021-07-14","2020-12-03","2020-12-03","2020-12-03","2021-08-11","2021-08-11","2021-02-09","2021-03-11","2020-07-06","2020-07-16","2020-12-21","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-09-15","2021-07-14","2021-02-09","2021-02-09","2021-03-10","2021-03-10","2021-03-11","2021-05-11","2021-06-14","2021-06-07","2021-05-20","2021-07-28","2021-08-19","2021-07-14","2021-07-14","2021-08-11"],"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[["","69238152301","TETRACYCLINE","CAP 500MG","","Select","Select",""],["","115166003","PROPRANOLOL","TAB 20MG","","Select","Select",""],["","50111033301","METRONIDAZOL","TAB 250MG","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","","Select","Select",""],["","53746051401","SPIRONOLACT","TAB 50MG","","Select","Select",""],["","65162044210","MECLIZINE","TAB 25MG","","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","","Select","Select",""],["","378020810","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","832105410","BACLOFEN","TAB 10MG","","Select","Select",""],["","69097084615","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","60505036302","OFLOXACIN","DRO 0.3%OTIC","","Select","Select",""],["","60505614904","CEFTRIAXONE","INJ 2GM","","Select","Select",""],["","378479106","FLUOROURACIL","CRE 0.05","","Select","Select",""],["","10702005601","OXYCODONE","TAB 10MG","","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","10702005601","OXYCODONE ","TAB 10MG","28","Select","Select",""],["","59746011506","PROCHLORPER ","TAB 10MG","30","Select","Select",""],["","115166003","PROPRANOLOL ","TAB 20MG","180","Select","Select",""],["","50111033301","METRONIDAZOL ","TAB 250MG","56","Select","Select",""],["","69238152301","TETRACYCLINE ","CAP 500MG","56","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","180","Select","Select",""],["","378020810","FUROSEMIDE ","TAB 20MG","90","Select","Select",""],["","65162044210","MECLIZINE ","TAB 25MG","42","Select","Select",""],["","53746051401","SPIRONOLACT ","TAB 50MG","90","Select","Select",""],["","378479106","FLUOROURACIL ","CRE 0.05","40","Select","Select",""],["","47335022090","KETOROLAC ","SOL 0.005","5","Select","Select",""],["","60505056000","OFLOXACIN ","DRO 0.3% OP","5","Select","Select",""],["","60758011905","PREDNISOLONE ","SUS 1% OP","10","Select","Select",""],["","832105410","BACLOFEN ","TAB 10MG","270","Select","Select",""],["","69097084615","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","60505614904","CEFTRIAXONE ","INJ 2GM","8","Select","Select",""],["","47335022090","KETOROLAC","0.005","5","Select","Select",""],["","60758011905","PREDNISOLONE","1% OP","10","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","",""],["Yes","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":""}]}]}