{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" M NERAKSNIKPOH","gend":1,"add":"53 N 7131TEERTS HT","city":"Richmond","state":"VA","zip":"23223-7713","dob":"1965-05-12","age":"","mstatus":"","insh":"10115095","cliId":"","pno":"6440872441","cno":8042003647,"email":"","ename":"","eno":"","pphy":"WOLVER, SUSAN E","ppno":8043278809,"pcpadd":"9109 STONY POINT DR N3 S3 DRIVE,","pcpcity":"Richmond","pcpstate":"VA","pcpzip":"23235-1979","pcpcounty":"","pcpid":"","pcpname":"MCV STONY POINT","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1317 N 35TH STREET","madd2":"","madd3":"","mcity":"Richmond","mstate":"VA","mzip":"23223-7713","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.3592","E11.3511","Z79.84","H43.12","H25.11","H40.053","Z96.1","H34.8320","H34.8322","E11.3311","H54.7","E11.9","I10","E66.01","E11.3593","E11.36","H35.353","E66.9","Z68.33","H00.024","K59.00","K31.84","Z68.38","R91.8","E11.3513","H34.8120","Z79.4","Z79.899","M54.9","M79.605","M25.552","E11.311","I95.1","H43.11","Z83.3","Z80.9","Z79.82","I95.2","Z23","D69.6","T14.8XXA","R30.0","R32","Z98.818","E65","E66.09","Z86.010","K64.4","A41.9","N39.0","E78.5","E86.0","K21.9","I95.9","Z87.440","Z68.36","E86.1","N12","R11.2","Z68.34","Z12.31","R10.32","K59.09","Z68.31","E11.43","Z13.9","B37.9","M19.072","M77.32","I70.90","R10.9","R53.83","H59.312","R82.4","Z74.09","E11.69","Z68.32","E11.40","M79.672","L84","E11.49","H34.8122","S39.012A","X50.0XXA","Y92.89","M54.50","R42","M16.12","Z12.11","Z71.3","E13.43","E11.319","M47.816","M16.0","R26.9","Z01.818","Z11.59","M79.3","R63.4","G89.29","N39.46","Z12.4","Z79.85","E55.9","N28.9","H34.8192","N17.9","N30.00","M79.89","D64.9","R50.84","K76.0","Z98.890","D62"],"date":["2022-01-17","2022-01-17","2023-01-20","2021-12-13","2022-01-17","2023-05-08","2023-05-08","2021-11-01","2023-05-08","2021-11-01","2021-11-01","2023-07-11","2023-06-18","2022-03-10","2022-11-28","2021-12-13","2021-11-01","2023-02-07","2022-02-24","2021-12-23","2021-01-08","2021-01-08","2021-01-08","2021-10-06","2023-05-08","2021-09-17","2022-02-22","2022-07-06","2022-07-05","2022-07-05","2022-09-02","2023-08-02","2022-08-10","2022-02-24","2022-02-24","2022-02-24","2022-07-06","2022-04-13","2022-10-25","2022-06-09","2022-11-21","2023-02-09","2022-10-25","2022-10-25","2023-07-15","2023-06-08","2021-02-17","2021-02-17","2022-07-07","2023-05-29","2022-07-06","2022-07-13","2023-03-15","2023-08-02","2022-07-06","2021-12-13","2022-07-06","2022-07-06","2022-07-06","2021-12-13","2022-08-02","2022-09-02","2022-03-04","2022-03-04","2023-03-15","2023-03-15","2022-06-15","2022-11-21","2022-11-21","2022-11-21","2022-07-06","2022-07-06","2021-03-29","2022-07-13","2022-07-13","2022-05-18","2022-05-18","2022-11-21","2022-11-21","2022-11-21","2022-11-21","2023-03-10","2022-06-26","2022-06-26","2022-06-26","2023-07-11","2021-11-11","2021-09-02","2021-02-17","2021-10-12","2022-02-24","2023-02-07","2022-06-26","2022-06-26","2022-07-07","2021-02-15","2021-02-15","2023-07-11","2023-07-11","2023-07-11","2023-02-09","2023-02-09","2023-03-10","2023-03-15","2023-05-29","2023-05-08","2023-06-08","2023-06-18","2023-08-02","2023-08-02","2023-07-13","2023-07-11","2023-07-13","2023-07-13"],"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":[["","00002143480","TRULICITY","INJ 1.5\/0.5","2","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","12","Select","Select",""],["","65862050301","AMOX\/K CLAV","TAB 875-125","10","Select","Select",""],["","67877022301","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","70010049105","METFORMIN HCL","ER ORAL TAB","120","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","10702000610","CYCLOBENZAPR","TAB 5MG","21","Select","Select",""],["","65162062710","TRAMADOL HCL","TAB 50MG","15","Select","Select",""],["","69367025605","METHOCARBAM","TAB 750MG","20","Select","Select",""],["","99073070827","FREESTYLE","TES LITE","100","Select","Select",""],["","65862050301","AMOX\/K","TAB 875-125","10","Select","Select",""],["","70010049105","METFORMIN","ER ORAL TAB","120","Select","Select",""],["","65162062710","TRAMADOL","TAB 50MG","15","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","00002143480","TRULICITY INJ","1.5\/0.5","2","Select","Select",""],["","60505258008","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","00406055201","OXYCODONE TAB","5MG","12","Select","Select",""],["","65862050301","AMOX\/K CLAV TAB","875-125","10","Select","Select",""],["","67877022301","GABAPENTIN CAP","300MG","60","Select","Select",""],["","70010049105","METFORMIN HCL ER ORAL TAB","","120","Select","Select",""],["","65862056099","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","10702000610","CYCLOBENZAPR TAB","5MG","21","Select","Select",""],["","65162062710","TRAMADOL HCL TAB","50MG","15","Select","Select",""],["","69367025605","METHOCARBAM TAB","750MG","20","Select","Select",""],["","99073070827","FREESTYLE TES LITE","","100","Select","Select",""],["","99073013001","FREESTYLE MIS LANCETS","","100","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":""}]}]}