{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ETTENLIWSGGUS L ","gend":1,"add":"NLAW6111EVIRD TU","city":"CHESTER","state":"VA","zip":"23836-6136","dob":"1968-11-19","age":"","mstatus":"","insh":"41019601","cliId":"","pno":"3440898859","cno":"","email":"","ename":"","eno":"","pphy":"WEISSKOHL, JACK CARIN","ppno":8048284571,"pcpadd":"417 N 11TH ST","pcpcity":"Richmond","pcpstate":"VA","pcpzip":"23298-5024","pcpcounty":"","pcpid":"","pcpname":"VCUHS AMBULATORY CARE CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"1116WALNUT DRIVE","add3":"","madd1":"1116WALNUT DRIVE","madd2":"","madd3":"","mcity":"CHESTER","mstate":"VA","mzip":"23836-6136","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.02","U07.1","R07.89","I10","I50.9","I25.10","E78.5","F32.9","E11.9","M48.061","G89.29","Z86.73","I21.9","R07.9","I45.10","I21.19","I49.3","I49.9","I51.7","I45.81","J90","R91.8","R09.89","Z98.1","R79.89","J96.01","I21.4","J12.82","I50.33","Z68.41","I42.9","I47.1","I11.0","E11.3293","Z95.5","E66.01","R94.31","I34.0","D50.9","I50.41","Z91.14","I50.43","R94.6","R11.0","I48.91","M48.00","Z79.01","I50.20","I48.92","N93.9","N17.9","I50.42","M54.9","I25.2","I21.A1","M41.9","K92.2","D64.9","Z79.02","D68.32","I24.8","D62","K21.9","N88.8","N95.0","D25.9","R42","I13.0","E11.22","N18.2","I69.354","I48.0","N80.9","E11.40","E11.319","M54.5","C54.1","Z11.51","Z11.59","Z11.4","E83.42","I50.30","D50.0","N17.8","J30.9","K59.00","J45.909","C56.9","I50.40","Z79.899","Z23","Z79.891","D25.2","K43.9","K80.20","E27.9","N20.0","I70.1","I70.0","K42.9","M47.817","E66.9","R06.00","I65.23","I65.29","I77.9","Z71.89","R41.3","I08.0","I87.8","I25.118","R55","Z85.42","I50.23","R57.0","R57.1","I49.01","T82.855A","Z20.822","E11.51","I25.82","R94.39","I67.82","G93.89","I25.119","Z01.818","R82.90","N18.30","L76.32","N93.8","I70.219","I70.208","L76.02","R00.8","Z45.2","Z46.82","R93.89","Z95.1","J81.1","Z98.890","J93.9","Q79.1","J98.11","J98.6","I31.3","Z48.812","I25.111","Z79.4","Z79.82","R00.0","I95.1","Z13.0","T81.89XA","R63.0","Z97.5","Z95.818","I49.8","I50.22","E11.43","R29.6","Z91.81","G47.33","W18.30XA","M16.0","M76.21","M76.22","I63.9","E11.65","M19.90","Z95.828","R77.8","R63.4","Z68.38","Z86.018","I25.810","K59.09","Z86.16","I50.21","R52","E11.69","Z92.29","E03.8","R06.89","K56.41","Z85.44","N39.0","K59.01","J45.40","R47.9","E11.42","I69.321","I69.322","E03.9","G81.94"],"date":["2022-05-24","2021-04-08","2021-02-10","2022-12-12","2022-05-24","2022-10-20","2022-12-12","2021-03-19","2022-10-20","2021-03-31","2022-10-27","2022-09-02","2021-02-16","2021-07-01","2021-02-16","2021-02-16","2021-11-04","2021-02-16","2022-05-24","2021-03-02","2021-08-30","2021-10-06","2021-08-23","2021-10-06","2021-10-06","2021-02-19","2021-10-11","2021-02-21","2021-02-16","2022-12-12","2021-09-20","2021-02-16","2021-11-02","2021-10-06","2021-12-09","2022-12-12","2021-11-04","2021-02-17","2021-11-02","2021-02-17","2021-02-20","2021-02-21","2022-10-20","2021-03-02","2022-06-21","2021-11-02","2022-10-27","2021-09-02","2021-08-13","2021-03-31","2021-08-15","2021-11-10","2021-09-02","2021-11-04","2021-10-06","2021-03-02","2021-03-02","2021-03-31","2022-10-27","2021-03-03","2021-03-03","2021-08-05","2021-06-08","2021-03-15","2021-03-04","2021-09-27","2022-06-21","2021-08-15","2021-08-15","2021-08-12","2021-04-08","2022-12-12","2021-04-08","2022-10-27","2021-03-12","2021-03-19","2022-06-21","2021-03-15","2021-03-15","2021-03-15","2021-11-02","2021-03-19","2021-03-19","2021-03-19","2021-03-19","2022-06-21","2022-12-12","2021-03-31","2021-06-15","2021-06-08","2021-04-27","2021-05-10","2021-06-04","2021-06-04","2022-06-21","2021-06-04","2021-06-04","2021-06-04","2021-08-22","2021-06-04","2021-06-04","2021-10-21","2022-09-02","2022-06-08","2021-07-07","2021-07-07","2021-07-27","2021-07-20","2021-08-05","2021-08-05","2021-08-05","2021-10-07","2021-08-05","2021-08-15","2021-08-05","2021-08-05","2021-08-05","2021-08-16","2021-10-06","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-08-16","2021-08-09","2021-08-12","2021-08-15","2021-08-13","2021-08-15","2021-08-14","2021-08-15","2021-08-15","2021-08-16","2021-08-16","2021-08-16","2021-08-20","2022-10-20","2021-08-28","2022-05-24","2021-08-20","2021-08-20","2021-08-21","2021-08-28","2021-08-26","2021-10-21","2021-10-21","2022-12-12","2021-10-21","2021-08-30","2021-12-09","2021-09-02","2021-09-03","2021-09-27","2022-06-01","2021-09-14","2021-10-06","2022-06-21","2021-10-06","2021-10-06","2021-10-06","2021-12-09","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-11","2021-10-10","2021-10-06","2021-10-07","2021-10-07","2021-10-07","2021-10-18","2021-10-18","2021-11-02","2021-12-09","2022-03-28","2022-05-16","2022-12-12","2022-05-24","2022-05-24","2022-05-24","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2022-10-27","2022-09-02","2022-09-02","2022-10-27","2022-10-27","2022-10-20","2022-12-12"],"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":[["","00054429731","FUROSEMIDE","TAB 20MG","180","Select","Select",""],["","16714079903","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","60258017101","MAG OXIDE","TAB 400MG","60","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","00245021211","MIDODRINE","TAB 5MG","45","Select","Select",""],["","00555060702","MEGESTROL AC","TAB 40MG","120","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","11534018028","POLYETH GLYC","POW 3350 NF","238","Select","Select",""],["","70677005801","SM SENNA LAX","TAB 8.6MG","60","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","99073070822","FREESTYLE","TES LITE","50","Select","Select",""],["","00904555159","BANOPHEN","TAB 25MG","2","Select","Select",""],["","00093317431","ALBUTEROL SUL","FAT E","8.5","Select","Select",""],["","16714085303","METOPROL SUC","TAB 50MG ER","30","Select","Select",""],["","16714008402","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","50458057930","XARELTO","TAB 20MG","30","Select","Select",""],["","10135031401","SENNA LAXATI","TAB 8.6MG","60","Select","Select",""],["","70377000913","ROSUVASTATIN","TAB 40MG","30","Select","Select",""],["","65862035705","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","65862006299","METOPROL TAR","TAB 25MG","30","Select","Select",""],["","16714066202","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","68462063945","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","65862055990","PANTOPRAZOLE","TAB 20MG","30","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","3","Select","Select",""],["","00173071920","FLOVENT HFA","AER 110MCG","12","Select","Select",""],["","57896044305","BISACODYL","SUP 10MG","12","Select","Select",""],["","42858011830","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","43386031208","GAVILAX","POW","238","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","60","Select","Select",""],["","00536121429","DIPHENHYDRAM","TAB 25MG","2","Select","Select",""],["","08290320122","BD PEN NEEDL","MIS 32GX4MM","30","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","21","Select","Select",""],["","62037099905","POT CL MICRO","TAB 20MEQ ER","14","Select","Select",""],["","68382022705","AMIODARONE","TAB 200MG","60","Select","Select",""],["","59762005601","MEDROXYPR AC","TAB 10MG","60","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","68382009205","CARVEDILOL","TAB 3.125MG","60","Select","Select",""],["","50111091701","TORSEMIDE","TAB 20MG","15","Select","Select",""],["","13107000130","MIRTAZAPINE","TAB 7.5MG","90","Select","Select",""],["","59762501002","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","67877049005","EZETIMIBE","TAB 10MG","30","Select","Select",""],["","00093216568","NALOXONE HCL","SPR 4MG","2","Select","Select",""],["","70010049105","METFORMIN HCL","ER ORAL TAB","60","Select","Select",""],["","08470114001","UNFINE PNTP","MIS 32GX4MM","30","Select","Select",""],["","00173071620","ADVAIR HFA","AER 115\/21","12","Select","Select",""],["","00363013820","SENNA","TAB 8.6MG","60","Select","Select",""],["","00363010908","GENTLE LAXAT","SUP 10MG","16","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","15","Select","Select",""],["","00904678744","MAG CITRATE","SOL LEMON","296","Select","Select",""],["","08290322057","BD LANCET UF","MIS 33G","100","Select","Select",""],["","56151014701","TRUPLUS LANC","MIS 33G","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":""}]}]}