{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" EILLIBEROOM S","gend":1,"add":"           RD ELTSAC 4134                         ","city":"HENRICO                  ","state":"VA","zip":"23231-9998","dob":"1960-07-07","age":"","mstatus":"","insh":"10111461","cliId":"","pno":"7740819699","cno":8049392835,"email":"","ename":"","eno":"","pphy":"CZAJKOWSKIIII, STANLEY","ppno":8047641253,"pcpadd":"8220 MEADOWBRIDGE RD STE 306,STE 332","pcpcity":"Mechanicsville","pcpstate":"VA","pcpzip":231162341,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT D                                             ","add3":"","madd1":"4314 CASTLE DR                                    ","madd2":"APT D                                             ","madd3":"","mcity":"HENRICO                  ","mstate":"VA","mzip":"23231-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G43.709","Z68.21","M54.30","F43.10","L72.0","L85.3","L21.9","R20.2","F29","F90.0","J01.10","R05.9","E11.9","K80.00","K80.12","K81.0","F90.9","F41.9","F32.9","I25.10","Z95.1","Z90.721","Z85.038","I10","I42.1","K58.9","M81.0","G40.909","Z79.899","Z79.84","E11.65","F41.8","J45.909","K21.9","J20.9","F90.2","K91.89","R10.9","Y83.8","I42.2","Z20.828","E11.40","G43.909","Z79.4","Z90.49","R10.11","K83.8","R10.31","K83.9","S36.13XA","K83.2","G89.29","F41.1","Z12.31","Z12.4","E11.69","K58.1","G56.23","G43.C0","F33.1","F43.9","Z68.22","Z98.890","Z95.0","Z68.20","E78.5","Z68.23","F43.12","I44.2","C54.1","D25.9","Z85.42","Z11.51","Z01.419","Z01.818","C55","Z85.43","R93.89","Z78.0","M21.619","Z01.812","Z20.822","U07.1","R05","R53.1","F06.31","E66.01","C67.9","M19.90","I48.91","F43.21","F20.1","F06.4","F22","F33.2","E13.8","I11.0","G56.00","L20.9","M79.7","Z00.00","F12.980","Z71.89","Z01.411","Z71.9","F32.0","R51.9","Z04.3","L56.8","G44.311","Z79.51","Z86.69","Z86.2","Z68.26","H90.3","W22.8XXA","W19.XXXA","H91.93","Z68.27","Z68.28"," ","M79.671","S99.921A","X50.1XXA"],"date":["2022-11-30","2020-10-21","2022-12-09","2022-12-07","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2022-08-09","2022-11-21","2021-11-19","2021-11-19","2021-04-20","2020-11-24","2020-11-27","2020-12-21","2020-11-24","2021-09-23","2021-04-20","2022-03-25","2021-04-20","2020-11-24","2021-03-25","2022-06-24","2022-08-16","2022-03-25","2022-03-25","2020-11-24","2022-03-25","2022-03-25","2022-12-07","2020-11-25","2022-03-25","2022-11-14","2021-12-02","2022-10-20","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2022-11-14","2020-12-09","2022-11-14","2020-12-09","2020-12-12","2020-12-09","2020-12-12","2020-12-12","2020-12-12","2020-12-11","2022-11-14","2022-12-07","2021-10-08","2020-12-21","2022-12-07","2020-12-21","2020-12-21","2020-12-21","2020-12-24","2020-12-24","2021-07-07","2020-02-14","2022-06-24","2020-02-21","2022-12-07","2021-04-20","2022-02-17","2022-05-17","2021-03-17","2021-03-17","2021-04-20","2021-03-17","2021-03-17","2021-03-23","2021-04-20","2021-03-25","2021-05-05","2021-03-25","2021-03-25","2021-03-26","2021-03-26","2021-03-26","2021-04-06","2021-04-06","2020-08-13","2021-04-20","2021-04-20","2022-03-25","2021-04-20","2021-07-15","2021-07-01","2021-07-08","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2021-09-28","2021-08-26","2020-09-14","2020-09-14","2020-09-14","2022-04-14","2022-03-25","2022-03-25","2022-03-25","2022-03-25","2022-03-25","2022-03-25","2022-03-25","2021-10-13","2022-04-19","2022-03-25","2022-03-25","2021-09-28","2022-05-11","2022-09-01","2022-12-09","2022-11-14","2022-11-14","2022-11-14"],"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":[["","10702025350","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","360","Select","Select",""],["","00023392102","BOTOX","INJ 200UNIT","1","Select","Select",""],["","64980029201","PERPHENAZINE","TAB 8MG","90","Select","Select",""],["","00555015902","CHLORDIAZEP","CAP 25MG","60","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","90","Select","Select",""],["","68382002310","ATENOLOL","TAB 50MG","180","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","70710122901","AMITRIPTYLIN","TAB 100MG","90","Select","Select",""],["","68382003616","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","60505317007","OMEGA-3-ACID","CAP 1GM","360","Select","Select",""],["","51672415403","CALCIPOTRIEN","OIN 0.00005","360","Select","Select",""],["","69097012403","TOPIRAMATE","TAB 100MG","90","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","6","Select","Select",""],["","00378963943","BUTORPHANOL","SOL 10MG\/ML","2.5","Select","Select",""],["","80777028299","MODERNA","INJ BA4\/BA5","0.5","Select","Select",""],["","00023649810","UBRELVY","TAB 50MG","10","Select","Select",""],["","70461032103","FLUCLVX","INJ 2021-22","0.5","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","12.00","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0.30","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":["",""]}},{"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":""}]}]}