{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"IRIS LOGAN","gend":1,"add":"708 S HARRISON STREET","city":"RICHMOND","state":"VA","zip":"23220-6472","dob":"1972-01-31","age":"","mstatus":"","insh":11000628,"cliId":"2FK2YP3RQ10","pno":8042372891,"cno":8042372891,"email":"","ename":"","eno":"","pphy":"LATHAM-SOLOMON, VICKI ","ppno":8043258801,"pcpadd":"6439 Iron Bridge Rd, ","pcpcity":"North Chesterfield","pcpstate":"VA","pcpzip":232345205,"pcpcounty":"","pcpid":"P9058394","pcpname":"BON SECOURS CANAL CROSSING INTERNAL MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT A ","add3":"","madd1":"708 S HARRISON STREET ","madd2":"APT A ","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23220-6472","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["J30.1","M16.31","M87.051","Z96.641","Z02.71","Z12.11","Z80.0","K57.30","K64.8","I10","M19.90","I45.10","Z79.899","Z95.2","R03.0","M16.11","J31.0","Z01.818","Z00.00","Z87.898","Z12.39","I51.7","R94.31","G89.29","M87.851","Z90.710","M16.9","M25.859","Z47.1","M25.552","J34.2","J34.3","R68.89","R51","M79.10","V49.50XA","M26.69","R73.03","S06.0X0S","Z12.31","S06.0X0D","T84.84XA","Z68.1","Z97.3","N76.0","N95.1","N95.2","N89.8","Z01.411","R63.6","Z01.419","Z11.2","Z11.8","Z71.3","R63.4","H40.003","H40.013","H18.893","H35.89","Z87.39","Z95.4","J30.9","Z68.20","E55.9","Z23","L81.9","Z86.79","F19.159","R41.82","F19.959","F17.200","R46.2","T50.901A","H10.45","H52.13","L30.8","Z68.21","Z12.72","Z11.51","J06.9","J02.9","R05","R09.81","H66.002","Z20.822","I63.9","I65.21","I63.231","I66.01","I77.1","I61.9","Q25.0","F14.10","Z98.890","R29.818","R29.712","I08.1","M79.669","M79.89","Q21.1","N28.89","N32.89","R29.810","R53.1","I82.90","R27.9","J98.6","D64.9","R09.89","I63.511","I63.031","G81.94","G62.9","R47.1","R13.10","R29.717","Z87.891","I63.89","I65.29","I63.311","I69.154","I69.192","I69.122","I69.118","I69.128","I69.391","F14.19","F81.9","R26.89","I69.198","H53.8","R41.4","I95.9","Z48.812","I69.354","N39.0","B96.20","R00.0","F14.90","N02.9","Z87.440","R82.90","R31.0","R47.02","I63.50","R41.841","N30.01","R26.81","F79","R26.2","M17.11","M62.81","K59.00","G47.00","K21.9","Q63.2"],"date":["2021-05-06","2018-02-19","2018-01-12","2021-08-30","2020-01-17","2019-01-18","2019-01-18","2019-01-18","2019-01-18","2021-08-30","2021-07-16","2019-01-18","2021-08-01","2021-08-30","2018-11-02","2021-08-30","2019-07-09","2018-02-12","2021-01-27","2020-05-11","2020-02-10","2018-02-12","2018-02-12","2018-02-13","2018-02-19","2021-08-01","2018-02-19","2018-02-20","2018-02-21","2019-03-01","2021-04-28","2021-04-28","2018-03-22","2019-05-30","2019-03-23","2019-03-23","2019-03-28","2021-08-01","2019-05-30","2021-06-15","2019-04-17","2018-04-23","2020-10-23","2018-05-11","2019-06-12","2018-08-29","2018-06-08","2019-06-12","2019-06-12","2019-06-25","2021-06-23","2020-06-17","2020-06-17","2019-06-25","2019-07-10","2020-08-04","2021-02-04","2020-08-04","2021-02-04","2018-08-25","2021-08-07","2018-11-02","2019-10-10","2018-11-02","2018-11-02","2019-11-08","2021-08-01","2021-02-28","2021-02-28","2021-02-28","2021-02-28","2021-02-28","2021-02-28","2021-04-28","2020-10-23","2021-01-27","2021-01-27","2021-06-23","2021-06-23","2021-07-23","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-08-01","2021-09-01","2021-08-01","2021-08-30","2021-08-07","2021-08-07","2021-08-07","2021-08-07","2021-08-30","2021-08-07","2021-08-03","2021-07-31","2021-08-05","2021-08-06","2021-08-06","2021-08-06","2021-08-05","2021-08-05","2021-07-31","2021-07-31","2021-08-03","2021-08-08","2021-08-03","2021-09-13","2021-08-03","2021-08-01","2021-08-01","2021-08-30","2021-08-01","2021-09-02","2021-08-30","2021-08-01","2021-08-01","2021-08-01","2021-07-31","2021-08-01","2021-09-08","2021-08-30","2021-08-30","2021-08-08","2021-08-08","2021-09-13","2021-08-08","2021-08-08","2021-08-08","2021-08-08","2021-08-08","2021-08-08","2021-08-08","2021-08-08","2021-09-17","2021-08-30","2021-08-30","2021-08-29","2021-08-30","2021-08-30","2021-08-25","2021-08-27","2021-09-16","2021-08-30","2021-09-17","2021-08-30","2021-08-30","2021-09-17","2021-08-30","2021-09-17","2021-08-30","2021-09-17","2021-08-30","2021-08-30","2021-08-30","2021-09-16"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","68382005101","MELOXICAM","TAB 15MG","","Select","Select",""],["","93310953","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","60505084805","AZELASTINE","SPR 0.0015","","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","","Select","Select",""],["","70461032003","FLUCLVX QUAD","INJ 2020-21","","Select","Select",""],["","33332031901","AFLURIA QUAD","INJ 2019-20","","Select","Select",""],["","49884029001","MEGESTROL AC","TAB 40MG","","Select","Select",""],["","603254421","BUT\/APAP\/CAF","TAB ","","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","","Select","Select",""],["","10702000750","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","60505058604","OLOPATADINE ","SOL 0.002","2.5","Select","Select",""],["","68382005101","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","16729018201","HYDROCHLOROT ","TAB 12.5MG","30","Select","Select",""],["","60432026415","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","45802002683","AZELASTINE ","SPR 0.0015","30","Select","Select",""],["","93310953","AMOXICILLIN ","CAP 500MG","12","Select","Select",""],["","45802006435","TRIAMCINOLON ","CRE 0.001","15","Select","Select",""],["","603254421","BUT\/APAP\/CAF ","TAB ","30","Select","Select",""],["","49884029001","MEGESTROL ","TAB 40MG","90","Select","Select",""],["","64380076921","PEG-3350\/KCL ","SOL \/SODIUM","4,000.00","Select","Select",""],["","70461032003","FLUCLVX ","INJ 2020-21","0.5","Select","Select",""],["","10702000750","CYCLOBENZAPR ","TAB 10MG","5","Select","Select",""],["","33332031901","AFLURIA ","2019-20","0.5","Select","Select",""],["","60505058604","OLOPATADINE","0.002","2.5","Select","Select",""],["","59746017506","PREDNISONE","20MG","8","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0.5","Select","Select",""],["","49884029001","MEGESTROL","40MG","90","Select","Select",""],["","33332031901","AFLURIA","2019-20","0.5","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","",""],["No","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":""}]}]}