{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"UC YSIADMAHGNINN","gend":1,"add":" RADEC155DAOR KROF","city":"RICHMOND ","state":"VA","zip":"23223-2722","dob":"1959-05-30","age":"","mstatus":"","insh":"10114731","cliId":"2EP8F94WU55","pno":"9940877457","cno":8049975477,"email":"","ename":"","eno":"","pphy":"SHEEHAN, MICHAEL DALE","ppno":8042262444,"pcpadd":"4620 S Laburnum Ave","pcpcity":"Henrico  ","pcpstate":"VA","pcpzip":232312424,"pcpcounty":"","pcpid":"P0113848","pcpname":"LABURNUM MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT 1 ","add3":"","madd1":"551CEDAR FORK ROAD","madd2":"APT 1 ","madd3":"","mcity":"RICHMOND ","mstate":"VA","mzip":"23223-2722","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M62.838","Z68.32","R06.02","E11.9","Z79.4","I15.9","E78.00","I25.10","R06.00","K21.9","Z79.82","Z79.899","Z87.891","Z87.01","Z95.1","Z95.5","M79.642","M79.641","M65.341","I21.4","I10","J81.0","N17.9","E11.42","N17.0","E11.22","E78.5","R50.9","R05","I51.9","J90","N18.32","N17.8","I12.9","Z68.34","N18.4","I50.33","E11.21","D64.9","Z12.31","Z68.31","D63.1","E11.51","E87.70","E66.9","Z20.822","Z90.49","F17.210","I20.9","I25.2","M19.041","M19.042","Z86.73","I42.8","I51.7","I25.119","Z01.818","Z03.818","I11.9","Z12.11","K59.04","K22.2","K59.09","K22.89"],"date":["2020-02-27","2020-09-18","2021-01-16","2021-03-18","2021-01-20","2020-08-24","2021-07-08","2021-10-05","2020-08-24","2021-10-29","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2021-10-11","2021-01-16","2020-12-03","2020-12-03","2020-12-03","2021-01-27","2021-10-05","2021-01-17","2021-01-20","2021-01-20","2021-01-16","2021-01-21","2021-01-16","2021-01-16","2021-01-16","2021-01-19","2021-01-19","2021-01-21","2021-01-21","2021-01-21","2021-01-20","2021-10-05","2021-01-27","2021-10-05","2021-10-05","2021-04-29","2021-04-29","2021-05-05","2021-01-16","2021-01-16","2021-01-16","2021-10-22","2021-01-16","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2021-01-18","2021-01-18","2021-01-19","2021-04-29","2021-06-25","2021-04-29","2021-10-29","2021-10-29","2021-10-29","2021-10-29","2021-10-29"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":{"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":[["","62175061743","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","169413212","OZEMPIC","INJ 2\/1.5ML","","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","","Select","Select",""],["","88221905","LANTUS SOLOS","INJ 100\/ML","","Select","Select",""],["","68382076010","METFORMIN","TAB 1000MG","","Select","Select",""],["","68382065005","ISOSORB MONO","TAB 30MG ER","","Select","Select",""],["","378021610","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","70377003012","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","57599000101","FREESTYLE","KIT SENSOR","","Select","Select",""],["","31722070190","LOSARTAN POT","TAB 50MG","","Select","Select",""],["","51672404806","CLOTRIM\/BETA","CRE DIPROP","","Select","Select",""],["","60505294509","EZETIMIBE","TAB 10MG","","Select","Select",""],["","13107008405","LORAZEPAM","TAB 1MG","","Select","Select",""],["","186077760","BRILINTA","TAB 90MG","","Select","Select",""],["","57664050658","METOPROL TAR","TAB 25MG","","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","8290320119","BD PEN NEEDL","MIS 31GX5MM","","Select","Select",""],["","88222033","LANTUS","INJ 100\/ML","","Select","Select",""],["","228212910","CLONIDINE","TAB 0.3MG","","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","","Select","Select",""],["","65862035790","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","65862020290","LOSARTAN ","TAB 50MG","90","Select","Select",""],["","88221905","LANTUS ","INJ 100\/ML","12","Select","Select",""],["","51672404806","CLOTRIM\/BETA ","CRE DIPROP","45","Select","Select",""],["","169413212","OZEMPIC ","INJ 2\/1.5ML","1.5","Select","Select",""],["","378021610","FUROSEMIDE ","TAB 40MG","90","Select","Select",""],["","65862035790","CLOPIDOGREL ","TAB 75MG","90","Select","Select",""],["","68382065005","ISOSORB ","TAB 30MG ER","90","Select","Select",""],["","68382076010","METFORMIN ","TAB 1000MG","225","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","75","Select","Select",""],["","70377003012","ATORVASTATIN ","TAB 80MG","90","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","186077760","BRILINTA ","TAB 90MG","60","Select","Select",""],["","57664050658","METOPROL ","TAB 25MG","180","Select","Select",""],["","228212910","CLONIDINE ","TAB 0.3MG","180","Select","Select",""],["","13107008405","LORAZEPAM ","TAB 1MG","30","Select","Select",""],["","60505294509","EZETIMIBE ","TAB 10MG","90","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","8290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","16729018201","HYDROCHLOROT ","TAB 12.5MG","90","Select","Select",""],["","42423027101","ALCOHOL ","MED 70%","100","Select","Select",""],["","832532510","POT  CL MICRO","20MEQ ER","30","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","21","Select","Select",""],["","10702025350","BUT\/APAP\/CAF ","","40","Select","Select",""],["","65862020290","LOSARTAN","50MG","90","Select","Select",""],["","68382065005","ISOSORB","30MG ER","90","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","57664050658","METOPROL","25MG","180","Select","Select",""],["","00832532510","POT CL MICRO","20MEQ ER","30","Select","Select",""],["","42423027101","ALCOHOL","MED 70%","100","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","","40","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","21","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","52268001201","SUPREP ","SOL PREP KIT","354","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","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}