{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" EIRALADSGNILLOR","gend":1,"add":"NYER 1003DAOR SDLO","city":"HENRICO                  ","state":"VA","zip":"23223-2109","dob":"1981-05-20","age":"","mstatus":"","insh":"00118452","cliId":"","pno":"8740868682","cno":8047828636,"email":"","ename":"","eno":"","pphy":"DICKERSON, TASHA B","ppno":8042257177,"pcpadd":"1510 N 28TH ST STE 300,","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232235311,"pcpcounty":"","pcpid":"","pcpname":"DOMINION MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"3001 REYNOLDS ROAD","madd2":"                                                  ","madd3":"","mcity":"HENRICO                  ","mstate":"VA","mzip":"23223-2109","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G10","S01.81XA","W19.XXXA","R32","R13.10","K59.00","M94.0","F41.8","J06.9","Z79.899","R26.89","R29.6","F02.80","Z79.1","Z87.891","R15.9","N39.41","F41.9","F32.9","S01.81XD","N39.0","F07.0","R47.1","G89.29","R51","S00.03XA","R07.81","M25.60","Z91.81","G24.9","R25.1","R25.2","F02.81","Z30.42","L02.31","R41.89","H10.33","H61.23","R63.4","R35.0","M79.601","R76.11","G25.5","M19.90","Z88.6","Z88.5","Z91.013","R25.9","H10.45","R39.81","Z01.411","Z11.51","N93.9","T19.2XXA","M25.69","D25.1","Z30.013","H91.90","R25.8","R09.81","N93.8","Z73.6","M62.81","R27.9","Z23","F32.A","R05","R30.0","R13.19","E55.9","M25.561","M25.562","H90.12","Z32.02","R13.12","H92.02","R07.89","R07.9","R52","W19.XXXD","M79.604","M79.605","Z00.00","G47.01","R05.9","E46","R05.8","L89.152","R60.0","R63.6","L89.42","H52.13","H04.123"],"date":["2022-11-07","2020-03-11","2020-03-11","2021-03-18","2022-10-26","2021-12-02","2021-12-02","2021-04-26","2019-03-12","2021-12-01","2020-06-16","2022-07-06","2021-07-15","2021-03-14","2022-05-10","2021-03-18","2022-10-16","2022-04-20","2021-08-30","2020-03-30","2020-04-01","2018-08-02","2020-02-28","2022-04-20","2019-01-25","2018-04-24","2021-04-28","2021-08-30","2022-07-06","2018-06-09","2018-05-01","2018-05-01","2018-06-12","2019-12-26","2020-05-22","2019-06-03","2018-06-04","2021-01-12","2021-08-30","2018-06-06","2018-06-06","2018-06-06","2018-06-09","2018-06-09","2018-06-09","2018-06-09","2018-06-09","2018-06-12","2018-06-18","2020-06-26","2018-07-12","2018-07-12","2018-07-24","2018-07-12","2021-07-15","2018-08-09","2018-08-09","2019-08-15","2021-08-30","2021-08-30","2018-09-11","2019-10-03","2019-10-03","2019-10-03","2022-10-18","2022-05-10","2021-02-01","2019-12-02","2021-12-02","2022-10-26","2018-12-27","2018-12-27","2021-01-12","2019-12-26","2022-05-10","2019-02-15","2018-03-05","2018-03-05","2022-10-26","2022-10-18","2022-03-25","2022-03-25","2022-10-18","2022-04-20","2022-07-06","2021-03-24","2022-07-06","2022-10-26","2022-10-26","2022-10-26","2022-10-18","2022-10-07","2022-10-07"],"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":[["","57237000805","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","180","Select","Select",""],["","69543038090","OLANZAPINE","TAB 2.5MG","30","Select","Select",""],["","50484001030","SANTYL","OIN 250\/GM","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","14","Select","Select",""],["","57664078486","CLONAZEP","TAB 0.25MG","60","Select","Select",""],["","00143314205","DOXYCYCL","CAP 100MG","10","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","49884023069","MEGESTROL","SUS 625MG\/5M","150","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","45802011222","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","59762453702","MEDROXYPR","INJ 150MG\/ML","1","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":""}]}]}