{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L LRAEPNWORB ","gend":1,"add":"EBMAHC 1034EVA ENYALR","city":"RICHMOND","state":"VA","zip":"23227-9998","dob":"1965-05-24","age":"","mstatus":"","insh":"00118738","cliId":"","pno":"5940869805","cno":8046295039,"email":"","ename":"","eno":"","pphy":"BROWN, LISA M","ppno":8044939999,"pcpadd":"18849 KINGS HWY,","pcpcity":"Montross","pcpstate":"VA","pcpzip":225202965,"pcpcounty":"","pcpid":"","pcpname":"WESTMORELAND MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT 21","add3":"","madd1":"4301 CHAMBERLAYNE AVE","madd2":"APT 21","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23227-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J30.89","J30.2","M10.9","E55.9","F41.8","I10","E11.8","G89.29","Z79.4","Z99.89","M19.90","F17.200","F41.1","F43.12","G47.00","T30.0","B49","K31.84","K21.9","E78.5","J45.909","Z68.28","F31.32","J45.40","Z74.1","E11.621","E11.49","F25.0","M79.605","M54.5","M79.662","R19.7","E11.9","M51.26","M47.816","J01.00","R51.9","H92.02","N20.0","R10.9","R10.11","Z87.442","E11.40","E11.69","F41.9","F31.9","M19.079","K58.9","F43.10","F17.210","Z88.5","Z88.2","Z79.51","Z23","R21","M79.604","M96.1","M54.16","Z98.890","Z71.3","Z71.89","L03.031","L60.0","B35.1","L73.8","L30.9","L85.3","L60.3","Z87.2","R31.9","G62.9","L85.1","Z79.84","E83.42","N12","R10.31","R11.2","K76.0","R05","N39.0","Z16.29","R31.0","J30.9","M54.9","F33.1","N13.30","J20.9","J40","R30.0","Z71.9","R35.0","N20.1","N13.2","K21.0","R73.9","R13.10","Z12.11","B37.3","Z01.818","E11.42","K31.89","K31.9","Z79.899","Z88.1","Z88.8","F32.9","K30","Z72.0","N63.20","Z01.419","R39.81","R15.9","R07.2","R07.89","R07.9","R06.02","Z92.3","D17.39","N64.89","N89.8","G56.13","G56.22","J01.90","E11.649","J32.9","R76.8","F90.2","M48.061","Q62.5","F33.3","F10.10","J45.50","E11.43","E08.42","Z87.891","J45.901","Z01.411","N76.0","N95.2","Z11.3","R20.2","J01.10","J34.89","Z20.828","R09.81","B35.3","R07.0","M19.071","M79.673","J06.9","M19.072","E11.65","H92.09","Z11.59","M54.2","Z03.89","Q62.69","M1A.9XX0","J44.9","M79.2","Z68.23","E08.29","Z12.31","R80.9","H52.203","H52.4","Z96.1"],"date":["2021-10-01","2020-12-12","2022-01-26","2020-12-12","2020-12-12","2022-08-16","2020-12-12","2022-07-22","2022-08-16","2020-12-12","2020-12-12","2020-12-12","2021-12-15","2020-12-12","2020-12-12","2020-12-12","2020-12-12","2020-12-12","2021-12-15","2022-01-26","2021-10-04","2020-12-12","2022-08-21","2021-12-15","2022-07-04","2021-07-29","2020-12-16","2021-12-15","2021-02-03","2021-07-14","2020-02-07","2019-12-17","2022-01-26","2021-03-17","2019-12-17","2021-01-11","2021-01-11","2021-03-09","2021-11-16","2021-11-16","2021-05-18","2021-01-14","2022-08-16","2021-09-08","2021-07-14","2021-02-03","2020-01-22","2020-01-22","2021-12-15","2021-07-14","2020-07-09","2020-01-22","2020-01-22","2022-01-26","2022-01-26","2021-02-03","2021-02-03","2020-02-07","2020-02-07","2020-06-23","2020-06-23","2020-02-26","2021-10-20","2021-10-20","2021-03-01","2021-03-01","2021-03-01","2021-03-05","2021-03-01","2020-05-21","2020-10-27","2021-07-07","2021-03-05","2020-08-06","2020-03-14","2020-03-14","2020-03-14","2020-05-21","2020-03-14","2020-04-29","2020-03-14","2021-05-21","2020-03-14","2021-03-17","2021-12-08","2020-07-02","2021-04-07","2021-04-07","2020-04-17","2020-10-27","2020-04-29","2021-11-16","2020-05-04","2020-06-01","2020-06-03","2020-07-21","2020-07-09","2020-07-28","2020-07-06","2021-12-15","2020-07-10","2020-07-09","2021-10-04","2020-07-09","2020-07-09","2021-07-14","2020-10-20","2022-08-22","2020-08-07","2020-07-28","2022-04-06","2022-04-06","2020-08-06","2020-08-06","2020-08-06","2020-08-06","2020-08-06","2020-08-07","2020-08-07","2022-04-25","2020-08-26","2020-08-26","2021-08-26","2021-08-31","2021-08-31","2021-08-31","2019-09-01","2020-09-01","2020-09-01","2020-11-12","2019-09-03","2022-08-22","2021-12-15","2021-10-20","2020-09-15","2020-11-11","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-11-18","2020-09-22","2020-09-22","2020-09-22","2021-09-23","2020-10-05","2019-11-18","2019-10-07","2021-10-20","2020-11-20","2021-10-20","2020-10-27","2020-10-27","2020-11-20","2019-11-18","2019-11-18","2022-04-25","2022-04-25","2022-08-22","2022-01-26","2021-12-15","2022-07-22","2022-07-22","2022-07-22","2022-08-16","2022-08-16","2022-08-16"],"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":[["","51672128402","TRIAMCINOLON","OIN 0.001","60","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","180","Select","Select",""],["","00254200801","COLCHICINE","TAB 0.6MG","7","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","90","Select","Select",""],["","00378718705","METFORMIN","TAB 1000MG","180","Select","Select",""],["","00093100301","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","67877025001","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","00172572960","FAMOTIDINE","TAB 40MG","90","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","27808003502","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","36","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","47335077991","AZELASTINE","SPR 0.001","60","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","12","Select","Select",""],["","00597010061","SPIRIVA","SPR 2.5MCG","12","Select","Select",""],["","00378320501","PRAZOSIN","CAP 5MG","60","Select","Select",""],["","16729013401","ALLOPURINOL","TAB 100MG","90","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","31722053401","METHOCARBAM","TAB 750MG","180","Select","Select",""],["","00378668999","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","66869040490","LIVALO","TAB 4MG","90","Select","Select",""],["","00173088210","BREO","INH 200-25","60","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","6","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00172392760","DIAZEPAM","TAB 10MG","1","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","00193709021","CONTOUR","TES BLD GLUC","200","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","28","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","51672130104","AMMONIUM","CRE 0.12","280","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","14","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","31722072320","LEVOFLOXACIN","TAB 750MG","7","Select","Select",""],["","66993058697","FLUTIC\/SALME","AER 500\/50","180","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","28","Select","Select",""],["","16729041401","DOXAZOSIN","TAB 2MG","30","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","76204060060","IPRATROPIUM\/","SOL ALBUTER","180","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","16","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00193658621","MICROLET","MIS LANCETS","200","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","59762040101","SUCRALFATE","TAB 1GM","270","Select","Select",""],["","00378161001","DICYCLOMINE","CAP 10MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","52817032010","BACLOFEN","TAB 10MG","90","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","84","Select","Select",""],["","59310057922","PROAIR","AER ","25.5","Select","Select",""],["","00046087221","PREMARIN","CRE 0.625MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","120","Select","Select",""],["","00378932232","WIXELA","AER 500\/50","180","Select","Select",""],["","70954005920","PREDNISONE","TAB 10MG","21","Select","Select",""],["","00115168974","BUDESONIDE","SUS 0.5MG\/2","120","Select","Select",""],["","60505083001","MOMETASONE","SPR 50MCG","17","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","70710122700","AMITRIPTYLIN","TAB 50MG","30","Select","Select",""],["","11917004813","INSULIN","MIS 1ML\/31G","100","Select","Select",""],["","33342020010","LEVOCETIRIZI","TAB 5MG","90","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","57237005860","CEFUROXIME","TAB 250MG","6","Select","Select",""],["","61314064511","NEO\/POLY\/HC","SUS 1% OTIC","10","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":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}