{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EEDEBEZYBLIM ","gend":0,"add":"             879 XOB .O.P                         ","city":"RICHMOND                 ","state":"VA","zip":"23218-0978","dob":"1957-11-18","age":"","mstatus":"","insh":"10110508","cliId":"","pno":"8340810447","cno":"","email":"","ename":"","eno":"","pphy":"COVINGTON, DAMIAN L","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":"P.O. BOX 978                                      ","madd2":"                                                  ","madd3":"","mcity":"RICHMOND                 ","mstate":"VA","mzip":"23218-0978","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N18.6","Z99.2","D50.9","N25.81","D63.1","Z01.812","U07.1","I42.2","I10","I49.1","I44.5","I12.0","T82.898A","T82.848A","T82.858A","I87.1","I25.2","R94.31","I95.9","I42.1","E87.2","Q61.3","E86.0","R55","K21.9","E86.1","I08.0","R00.1","Z23","S40.222A","L98.8","Q27.30","Z49.01","Z01.818","R06.00","Z87.891"," "],"date":["2022-11-02","2022-11-02","2022-09-02","2022-11-02","2022-11-02","2022-01-28","2022-02-05","2022-02-05","2022-02-05","2022-02-08","2022-02-08","2022-03-17","2021-11-09","2021-07-16","2021-07-16","2021-07-16","2021-09-19","2021-09-19","2021-09-20","2021-09-19","2021-09-20","2021-09-19","2021-09-19","2021-09-19","2021-09-19","2021-09-19","2021-09-21","2021-09-22","2021-10-01","2021-10-07","2021-11-09","2021-11-09","2021-12-21","2022-03-17","2022-03-17","2022-03-17","2022-11-02"],"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":[["","59922063101","AURYXIA","TAB 210MG","240","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","49884012301","LABETALOL","TAB 200MG","180","Select","Select",""],["","53489038701","MINOXIDIL","TAB 10MG","30","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","30","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}