{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LOUELLA M BAILEY","gend":1,"add":"607 EPPES ST","city":"HOPEWELL ","state":"VA","zip":"23860-2418","dob":"1963-06-02","age":"","mstatus":"","insh":11000297,"cliId":"5N99FJ8PC19","pno":8044025073,"cno":8044025073,"email":"","ename":"","eno":"","pphy":"PASCO, HAYDEN  ","ppno":8042391640,"pcpadd":"12018 W Broad St Ste 100","pcpcity":"Richmond ","pcpstate":"VA","pcpzip":232337796,"pcpcounty":"","pcpid":"P0124051","pcpname":"PRIMARY HEALTH GROUP INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"607 EPPES ST","madd2":"","madd3":"","mcity":"HOPEWELL ","mstate":"VA","mzip":"23860-2418","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I49.9","K52.9","R10.9","I11.0","I50.9","E78.5","Z95.810","Z86.74","R93.3","Z28.21","Z12.31","Z12.11","D48.5","M85.9","E28.9","K57.33","C44.42","D23.4","R22.0","D23.9","N63.10","N63.11","N60.11","Z00.00","I10","L08.89","E66.9","Z68.35","L72.0","I47.2","I51.81","T81.40XA","Z79.899","Z45.02","I42.8","I34.0","N93.9","M54.2","M25.511","S13.4XXA","X50.0XXA","S43.401A","I42.9","I49.01","I46.2","I46.9","Z97.3","Z86.39","Z86.79","Z98.890","Z85.828","Z91.81","I48.91","I47.1","H52.03","Z79.82","Z68.37","U07.1","Z20.822","I25.10","E66.01","Z95.0","L91.0","N20.1","R35.0","R10.31","Z90.49","Z90.710","N13.30"],"date":["2021-08-27","2020-01-05","2020-01-05","2021-11-01","2021-11-01","2021-07-01","2021-09-01","2021-02-26","2020-01-05","2019-01-10","2019-01-16","2019-02-25","2019-01-10","2019-01-15","2019-01-15","2020-01-15","2019-01-23","2019-01-23","2019-02-01","2019-01-23","2019-01-28","2019-01-28","2019-01-28","2021-08-27","2021-08-27","2019-02-01","2020-12-22","2021-08-27","2019-02-01","2021-02-26","2021-09-01","2019-02-11","2019-02-25","2021-05-28","2020-02-28","2019-05-31","2018-04-26","2019-04-28","2019-04-28","2019-04-28","2019-04-28","2019-04-28","2021-05-28","2020-06-05","2020-06-05","2021-09-01","2020-12-22","2019-12-27","2019-12-27","2019-12-27","2019-12-27","2020-12-22","2021-02-26","2021-02-26","2020-12-22","2020-12-22","2020-12-22","2021-07-01","2021-07-01","2021-07-01","2021-08-27","2021-08-27","2021-08-27","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-01"],"priorHcc":["","","",null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null,null,null,null]}},{"a":[]}]},{"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","50742061601","METOPROL SUC","TAB 50MG ER","","Select","Select",""],["","78077720","ENTRESTO","TAB 49-51MG","","Select","Select",""],["","143992801","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","378214601","SPIRONOLACT","TAB 25MG","","Select","Select",""],["","65862020390","LOSARTAN POT","TAB 100MG","","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","","Select","Select",""],["","65162062710","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","143924920","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","","Select","Select",""],["","69543038810","KETOROLAC","TAB 10MG","","Select","Select",""],["","65862019105","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","","Select","Select",""],["","50742061601","METOPROL ","TAB 50MG ER","90","Select","Select",""],["","67877019805","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","65862020390","LOSARTAN ","TAB 100MG","90","Select","Select",""],["","378214601","SPIRONOLACT ","TAB 25MG","90","Select","Select",""],["","78077720","ENTRESTO ","TAB 49-51MG","180","Select","Select",""],["","143992801","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","43386009019","GAVILYTE-G ","SOL ","4,000.00","Select","Select",""],["","143924920","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","65162062710","TRAMADOL ","TAB 50MG","10","Select","Select",""],["","64380076921","PEG-3350\/KCL ","\/SODIUM","4,000.00","Select","Select",""],["","65862019105","CYCLOBENZAPR ","10MG","40","Select","Select",""],["","69543038810","KETOROLAC ","10MG","20","Select","Select",""],["","65862020390","LOSARTAN","100MG","90","Select","Select",""],["","50742061601","METOPROL","50MG ER","90","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","65162062710","TRAMADOL","50MG","10","Select","Select",""],["","67877021901","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","31722099601","HYDROCO\/APAP ","TAB 5-325MG","8","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}