{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AILETOPMURC B","gend":1,"add":"            DR GNIMELF 02                         ","city":"CUMBERLAND               ","state":"VA","zip":"23040-9998","dob":"1933-12-17","age":"","mstatus":"","insh":"00117595","cliId":"","pno":"9440804442","cno":8044410380,"email":"","ename":"","eno":"","pphy":"RAVUSSIN, JEREMY","ppno":8044238470,"pcpadd":"611 WATKINS CENTRE PKWY STE 250,STE 117","pcpcity":"Midlothian","pcpstate":"VA","pcpzip":231144404,"pcpcounty":"","pcpid":"","pcpname":"INTERNAL MEDICINE ASSOCIATES OF CHESTERFIELD","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"20 FLEMING RD                                     ","madd2":"                                                  ","madd3":"","mcity":"CUMBERLAND               ","mstate":"VA","mzip":"23040-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","M54.2","I10","M25.561","M25.661","R07.89","R60.9","I49.49","R06.02","H40.2234","Z96.1","M25.551","M17.11","M25.461","Z86.73","U07.1","R09.89","R53.83","E86.0","E87.1","J01.90","E78.00","K21.9","Z87.19","Z87.891","Z82.49","M25.512","Z23","I13.10","G45.9","Z68.30","E66.9","N28.9","Z86.79","Z20.822","E78.5","R00.0","R68.81","H40.1131","T88.1XXA","T45.525A","I48.91","I48.92","M06.9","Z79.82","Z00.00","Z71.89","I49.1","R73.01","Z09","Z12.31","I44.0","R13.10","L73.9","R10.31","B35.1","M79.674","M79.675","R53.1","A41.9","J96.01","R19.2","R00.2","M50.90","M75.82","R55","R07.2","L03.011","L60.0","M25.571","M21.41","L84","K59.09","H40.1132","H35.373","H43.813","I12.9","N18.3","I49.9","I48.0","M19.90","Z90.49","Z88.0","Z20.9","R50.9","F41.9","R91.8","R05","R35.0","G47.00","K59.00","I35.8","I34.8","I49.3","A41.89","J12.82","Z66","Z79.1","Z79.2","R42","Z68.29","G89.29","R09.81","R19.5","K22.4","Z78.9","N17.9","Z91.81","K52.9","R94.4","J31.0","R03.0","Z79.899","Z91.09","G25.81","Z68.27","J34.0","M20.41","M20.42","G58.8","H40.2232","R00.1","T46.2X5A","N18.30","H40.9","F17.210","I70.203","E66.3","B37.9","R21","Z68.28","R60.0","I73.9","I16.0","R20.2","H53.8","R51.9","N18.31","Z88.2","M19.012","I89.0","Z99.89","K29.70","K31.89","R46.4","N90.7","J30.2","B37.3","S30.814A","S30.816A","R94.31","R20.0","R14.0","K59.04","L02.211","M75.30","D64.9","N25.81","L65.0","L21.8","G47.33","F03.90","N39.0","H26.9","R40.4","L60.8","I95.2","Z86.16","T46.5X5A","T46.4X5A","L72.0","H04.123","R10.13","R10.9","K44.9","K57.30","R90.82","J30.9","R80.9","D63.8","E55.9","E21.3","R47.01","Z79.02","M79.671","M79.672","Z01.89","M62.81","R40.0","T88.7XXA","R54","E83.9","D63.1"," ","R05.9","J34.89"],"date":["2021-04-30","2020-08-20","2022-12-06","2019-06-13","2019-06-13","2021-04-30","2022-09-06","2022-12-06","2021-10-01","2021-08-24","2022-07-11","2019-04-01","2019-04-09","2019-04-01","2022-09-06","2021-04-30","2021-03-26","2021-03-26","2021-03-26","2022-06-06","2022-08-31","2022-06-07","2022-12-02","2021-03-26","2021-10-02","2021-04-01","2022-11-08","2022-11-08","2020-08-24","2021-10-02","2020-09-17","2021-03-07","2019-09-30","2019-09-30","2022-06-07","2022-11-08","2019-05-20","2022-12-02","2020-04-16","2021-10-10","2021-10-10","2021-08-24","2020-02-15","2022-06-04","2022-06-07","2021-12-29","2021-12-29","2022-06-27","2021-12-29","2022-06-27","2022-01-28","2020-02-15","2020-09-18","2019-09-01","2021-03-18","2022-07-26","2022-05-24","2022-05-24","2022-06-07","2021-04-01","2021-04-01","2020-08-06","2021-10-08","2020-06-04","2020-06-04","2022-12-06","2022-12-06","2021-12-12","2021-12-12","2019-01-17","2019-01-17","2019-01-17","2020-06-18","2022-07-11","2022-07-11","2022-07-11","2022-05-13","2020-09-17","2020-08-24","2020-08-24","2020-08-24","2022-06-07","2022-06-07","2021-03-31","2021-03-31","2022-08-08","2021-04-30","2020-08-20","2021-09-28","2021-09-28","2022-12-02","2021-05-19","2022-06-09","2022-06-04","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2022-06-06","2021-04-09","2022-04-06","2022-08-31","2021-03-18","2022-12-02","2022-12-02","2022-06-09","2020-08-24","2020-09-18","2020-07-20","2019-07-30","2021-08-01","2022-06-27","2021-08-23","2021-08-23","2022-11-08","2021-07-01","2019-05-01","2019-05-01","2019-05-01","2022-01-11","2022-06-04","2021-10-04","2022-05-13","2021-10-04","2021-10-04","2022-07-26","2021-06-28","2019-06-28","2019-06-28","2021-06-28","2020-11-18","2019-06-17","2022-06-06","2021-02-06","2022-06-04","2021-02-06","2021-02-06","2022-06-07","2020-02-15","2019-09-09","2021-10-02","2022-12-02","2022-12-02","2022-06-07","2019-11-11","2021-03-22","2021-04-19","2021-04-19","2021-04-19","2022-06-07","2021-02-06","2021-07-27","2020-07-24","2021-06-25","2019-11-20","2020-11-18","2020-11-18","2019-03-25","2019-03-25","2021-08-24","2021-08-24","2021-10-02","2021-10-02","2022-06-07","2019-03-25","2021-05-18","2022-06-07","2021-05-18","2021-05-18","2021-07-07","2022-07-11","2022-06-09","2022-06-07","2022-06-07","2022-06-07","2022-06-07","2022-08-08","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2022-06-07","2022-06-07","2022-05-26","2022-05-26","2022-05-11","2022-06-07","2022-06-07","2022-09-09","2022-09-08","2022-05-13","2022-05-13","2022-12-06","2022-08-31","2022-08-31"],"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":[["","00023932105","ALPHAGAN","SOL 0.001","5","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","15","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00781618556","TRAVOPROST","DRO 0.00004","2.5","Select","Select",""],["","62175061746","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","70377000812","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","43547035611","LISINOPRIL","TAB 40MG","30","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","00054004544","IPRATROPIUM","SPR 0.0003","30","Select","Select",""],["","50111032703","HYDRALAZINE","TAB 25MG","90","Select","Select",""],["","00054001221","FLECAINIDE","TAB 150MG","30","Select","Select",""],["","69097012715","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","69315015501","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","63304061650","DOXYCYC","CAP 100MG","10","Select","Select",""],["","00172409680","BACLOFEN","TAB 10MG","30","Select","Select",""],["","59746021605","SPIRONOLACT","TAB 25MG","15","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","50383077932","LACTULOSE","SOL 10GM\/15","900","Select","Select",""],["","00781223410","OMEPRAZOLE","CAP 40MG","10","Select","Select",""],["","00065026025","TRAVATAN","DRO 0.00004","2.5","Select","Select",""],["","00054418625","DEXAMETHASON","TAB 6MG","7","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","29300013510","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","33342032186","CLOBETASOL","SOL 0.0005","50","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","3","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00713068615","NYSTATIN","OIN 100000","45","Select","Select",""],["","61442010310","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","57664050318","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00168020437","LIDOCAINE","OIN 0.05","248.08","Select","Select",""],["","40085071645","DOXEPIN","CRE 0.05","180","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":""}]}]}