{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"F EILLIWNODROG ","gend":0,"add":"EDAV 415EVIRD N","city":"RICHMOND","state":"VA","zip":23225,"dob":"1946-12-28","age":"","mstatus":"","insh":"10118644","cliId":"","pno":"3240860657","cno":"8042305973","email":"","ename":"","eno":"","pphy":"CLARK, RALPH R","ppno":8042375606,"pcpadd":"417 N 11TH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23298,"pcpcounty":"","pcpid":"","pcpname":"MCV AMBULATORY CARE CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"514 VADEN DRIVE","madd2":"","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23225-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.0","I10","F20.9","D69.6","E03.9","E55.9","D64.9","D32.9","Z11.59","K56.41","N28.1","N32.9","R50.9","K59.00","K64.9","Z12.11","R00.1","R94.31","M62.81","E22.1","R10.9","K60.2","K62.3","R63.4","G24.01","E53.8","E78.5","E23.0","E11.9","Z20.828","H54.8","Z79.899","Z86.011","K64.1","H54.7","F91.8","R46.89"],"date":["2022-01-14","2021-04-09","2021-04-09","2021-04-23","2021-04-09","2021-04-09","2021-04-23","2020-07-15","2020-07-11","2020-11-13","2020-11-13","2020-11-13","2020-11-15","2020-12-04","2020-11-15","2021-01-12","2020-11-14","2020-11-14","2020-11-15","2020-08-01","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-12-04","2020-07-15","2020-07-15","2020-07-29"],"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":[["","68180045001","QUETIAPINE","TAB 400MG","30.00","Select","Select",""],["","69315013610","BENZTROPINE","TAB 0.5MG","60.00","Select","Select",""],["","16729016917","ESCITALOPRAM","TAB 10MG","30.00","Select","Select",""],["","60505017007","PRAVASTATIN","TAB 40MG","30.00","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","5.00","Select","Select",""],["","69097012715","AMLODIPINE","TAB 5MG","30.00","Select","Select",""],["","00378182310","LEVOTHYROXIN","TAB 137MCG","30.00","Select","Select",""],["","33332032002","AFLURIA","INJ 2020-21","0.50","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","24.00","Select","Select",""],["","10572010101","PEG-3350","SOL ELECTROL","4,000.00","Select","Select",""],["","70461012103","FLUAD","INJ 2021-22","0.50","Select","Select",""],["","17478071130","LIDOCAINE","GEL 2% JELLY","30.00","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":""}]}]}