{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ECINREBNOTROM M","gend":1,"add":"        DR NRUBKCALB 2091                         ","city":"GLEN ALLEN               ","state":"VA","zip":"23060-9998","dob":"1944-06-21","age":"","mstatus":"","insh":"00113991","cliId":"","pno":"6340858786","cno":"","email":"","ename":"","eno":"","pphy":"IVEY, ABENA T","ppno":8047557581,"pcpadd":"10150 STAPLES MILL RD STE C,STE C","pcpcity":"Glen Allen","pcpstate":"VA","pcpzip":230603452,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT D                                             ","add3":"","madd1":"1902 BLACKBURN RD                                 ","madd2":"APT D                                             ","madd3":"","mcity":"GLEN ALLEN               ","mstate":"VA","mzip":"23060-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H25.12","I10","R35.0","R73.01","E78.00","R79.89","R10.2","N76.0","Z68.32","J98.11","R93.89","J43.9","I27.21","E66.9","E78.5","H26.9","H73.93","J30.9","K08.109","M05.79","M81.0","M85.9","R06.02","R06.2","R93.8","R91.1","Z71.9","Z92.29","M06.9","J44.9","Z87.891","Z00.00","R73.03","Z71.89","L65.9","R91.8","J01.00","J84.9","M80.80XD","J98.4","J43.2","J30.2","K21.9","E87.1","Z87.09","J20.9","Z68.34","Z86.19","M19.041","M19.042","Z68.33","Z79.899","H40.1131","H25.13","Z68.35","Z12.31","H40.1132","H35.3131","J01.01","Z13.31","J41.1","R05","S39.011A","Z01.818","H25.9","R05.9","H25.11","J45.909","Z23","I25.10","H44.9","Z13.820","M85.80","Z78.0","M17.0","M65.4","Z01.419","M85.832","Z88.9","J45.40","R09.89","R23.3","R39.15","Z79.1","Z79.51","Z79.83","Z97.2","Z97.3","H25.042","S05.02XA","H25.041","I12.9","N18.30"," ","H43.811"],"date":["2022-02-17","2022-09-20","2019-02-21","2019-09-19","2022-07-26","2021-09-22","2019-02-21","2019-02-21","2022-09-20","2021-03-19","2022-04-20","2021-03-19","2021-03-19","2022-07-07","2021-04-10","2018-04-10","2018-04-10","2022-01-26","2018-04-10","2022-10-14","2018-04-10","2018-04-10","2018-04-10","2018-04-10","2018-07-17","2020-03-27","2022-07-07","2019-05-16","2022-10-26","2022-12-06","2022-07-26","2021-09-22","2022-07-26","2021-09-22","2022-01-26","2021-12-21","2020-08-11","2020-06-09","2020-06-09","2019-10-29","2018-08-23","2022-04-20","2022-02-11","2022-01-26","2019-11-26","2020-01-06","2020-01-06","2022-10-26","2022-10-14","2022-10-14","2022-05-10","2022-07-26","2021-12-07","2022-11-08","2021-10-26","2019-12-19","2022-08-10","2022-01-28","2019-09-19","2019-06-18","2022-04-20","2020-01-12","2020-01-12","2022-02-07","2022-02-07","2022-02-07","2022-02-28","2021-04-10","2019-09-19","2019-10-29","2021-12-16","2019-12-19","2019-12-19","2019-12-19","2018-03-06","2018-03-06","2019-04-26","2019-12-19","2022-01-26","2018-02-23","2018-04-10","2018-04-10","2018-04-10","2018-04-10","2022-07-26","2018-04-10","2018-04-10","2018-04-10","2022-02-17","2022-02-22","2022-02-28","2022-07-26","2022-07-26","2022-12-06","2022-11-08"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","69097052444","DICLOFENAC","GEL 0.01","600","Select","Select",""],["","60505056000","OFLOXACIN","DRO 0.3% OP","5.00","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5.00","Select","Select",""],["","42571013725","KETOROLAC","SOL 0.005","5.00","Select","Select",""],["","13668015930","TELMISA\/HCTZ","TAB 40-12.5","90","Select","Select",""],["","00597010061","SPIRIVA","SPR 2.5MCG","4","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00093742698","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","25.5","Select","Select",""],["","00378001401","METHOTREXATE","TAB 2.5MG","72","Select","Select",""],["","65862032904","ALENDRONATE","TAB 70MG","12","Select","Select",""],["","70377000315","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","00173088210","BREO","INH 200-25","60","Select","Select",""],["","47335093890","AZELASTINE","DRO 0.0005","36","Select","Select",""],["","68180030260","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","33342002208","LEVOFLOXACIN","TAB 500MG","10.00","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0.25","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","70710115803","LEFLUNOMIDE","TAB 20MG","90","Select","Select",""],["","49281012165","FLUZONE","INJ 2021-22","0.7","Select","Select",""],["","00005197102","PREVNAR","INJ ","0.5","Select","Select",""],["","24208083060","NEO\/POLY\/DEX","SUS 0.1% OP","5.00","Select","Select",""],["","59310057922","PROAIR","AER ","25.5","Select","Select",""],["","70461012003","FLUAD","INJ 0.5ML","0.5","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","20","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00378064010","PREDNISONE","TAB 5MG","30","Select","Select",""],["","43598072101","HYDROXYCHLOR","TAB 200MG","90.00","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}