{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"T YRNEHSNOMMI","gend":0,"add":" kaO 808evA kraP","city":"Richmond","state":"VA","zip":"23222-1028","dob":"1951-01-26","age":"","mstatus":"","insh":"00119415","cliId":"","pno":"1340897469","cno":"","email":"","ename":"","eno":"","pphy":"DAVIS, LINDSEY BLAIR ANN","ppno":8048285883,"pcpadd":"401 N 11TH ST,","pcpcity":"Richmond","pcpstate":"VA","pcpzip":"23219-1901","pcpcounty":"","pcpid":"","pcpname":"MCV NELSON CLINIC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"808 Oak Park Ave","madd2":"","madd3":"","mcity":"Richmond","mstate":"VA","mzip":"23222-1028","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E55.9","Z00.00","C61","Z12.11","D12.3","K57.30","K64.8","K64.4","R97.20","Z68.34","I10","R30.0","E78.2","I48.91","R10.30","K58.1","Z13.5","R39.11","Z76.89","I42.9","I83.813","J30.89","N41.1","E78.00","I48.0","Z01.810","R94.31","M25.559","R31.29","T63.481A","I42.2","R06.00","H25.13","H40.053","H33.002","R07.9","H40.1122","H40.1111","Z96.1","Z71.2","D89.89","U07.1","K08.89","R43.0","R43.2","M25.572","Z82.49","I50.9","H25.11","Z20.89","N50.82","H35.372","Z79.899","E78.5","Z20.822","N43.40","I86.1","Z79.01","Z96.642","R31.21","M77.32","M79.89","N41.9","E66.01","N40.0","Z96.643","H40.013","N50.811","N50.812","G89.29","R39.89","T84.061A","E66.9","R10.84","R10.13","M25.552","M25.551","R10.32","Z68.35","N17.9","Z20.828","M19.90","F17.200","F12.90","K59.00","R40.2363","R40.2253","R07.89","T78.40XD","L30.9","N52.9","I51.9","Z01.818","R74.8","Z12.5","Z11.59","R05","N48.89","Z13.220","Z13.1","Z68.32","L29.9","R94.5","Z23","R31.9","Z98.42","B00.9","R31.0","K86.89","I70.0","Z80.42","I45.10","K63.5","H25.12","Z01.812","N43.41","N50.3","T78.3XXA","R22.0","M85.88","M47.817","H04.123","Z86.69","Z87.438"],"date":["2021-12-10","2021-12-10","2022-07-27","2021-12-12","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2020-10-08","2021-08-25","2022-05-24","2022-07-27","2021-12-10","2022-05-24","2020-10-08","2020-11-11","2020-10-08","2021-08-10","2021-11-24","2022-05-24","2021-12-10","2021-12-10","2020-07-21","2020-01-20","2021-08-30","2021-08-30","2021-08-30","2019-04-08","2021-05-19","2020-01-25","2020-10-15","2020-10-15","2022-06-16","2021-12-16","2021-09-23","2020-10-02","2022-10-17","2022-10-17","2022-10-17","2021-12-10","2019-09-25","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-11-16","2021-11-16","2021-01-20","2022-05-24","2022-10-17","2022-05-24","2022-05-24","2022-05-24","2022-05-24","2022-05-24","2022-05-24","2022-05-24","2019-04-04","2020-10-02","2020-10-02","2019-04-18","2021-12-10","2021-05-20","2021-05-19","2020-10-21","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2019-04-08","2021-08-10","2019-04-01","2019-03-26","2019-04-08","2019-04-04","2019-03-26","2021-12-10","2020-10-04","2020-10-01","2021-11-09","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-05-18","2021-08-25","2020-10-20","2020-10-20","2022-05-18","2020-01-20","2019-04-04","2019-04-04","2021-01-20","2021-08-10","2019-04-04","2019-04-04","2019-09-23","2020-01-25","2019-04-01","2021-12-10","2021-05-20","2021-11-10","2022-02-03","2021-05-19","2021-05-19","2021-05-19","2019-09-06","2020-10-01","2021-07-01","2021-11-09","2021-06-29","2022-05-04","2022-05-04","2020-05-12","2020-05-12","2019-04-08","2019-04-08","2021-12-16","2021-12-16","2020-07-15"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":[["","68682000710","DILTIAZEM","TAB 60MG","120","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0.3","Select","Select",""],["","49281012065","FLUZONE HD","INJ PF 20-21","0.7","Select","Select",""],["","70010002703","TROSPIUM CHL","CAP 60MG ER","7","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","12","Select","Select",""],["","68645049659","CARVEDILOL","TAB 25MG","60","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","6","Select","Select",""],["","24208046325","LATANOPROST","SOL 0.00005","2.5","Select","Select",""],["","42571014726","DORZOL\/TIMOL","SOL 22.3-6.8","10","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","3","Select","Select",""],["","23155053006","TROSPIUM CL","TAB 20MG","10","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","00527293437","PREDNISONE","TAB 20MG","3","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","6","Select","Select",""],["","60505001406","DILT-XR","CAP 120MG","90","Select","Select",""],["","13107008405","LORAZEPAM","TAB 1MG","2","Select","Select",""],["","51672131200","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","65862042001","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","68180063609","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00228282011","HYDROCHLOROT","TAB 12.5MG","90","Select","Select",""],["","00781217660","CEFDINIR","CAP 300MG","6","Select","Select",""],["","42806055212","OMEGA-3-ACID","CAP 1GM","30","Select","Select",""],["","00168000415","TRIAMCINOLON","CRE 0.001","45","Select","Select",""],["","31722070490","VALACYCLOVIR","TAB 500MG","4","Select","Select",""],["","59267030402","PFIZER","INJ BA4\/BA5","0.3","Select","Select",""],["","49281012065","FLUZONE","INJ PF 20-21","0.7","Select","Select",""],["","23155053006","TROSPIUM","TAB 20MG","10","Select","Select",""],["","65862042001","SMZ\/TMP","TAB 800-160","20","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":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}