{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LULA M RICHARDSON","gend":1,"add":"4708 LINDLAW AVENUE  ","city":"RICHMOND ","state":"VA","zip":"23234-3125","dob":"1946-02-08","age":"","mstatus":"","insh":11000959,"cliId":"5NY8MN9EE41","pno":8042757077,"cno":8042757077,"email":"","ename":"","eno":"","pphy":"MULLET, EMILY K","ppno":8048285883,"pcpadd":"4730 N Southside Plaza St","pcpcity":"Richmond ","pcpstate":"VA","pcpzip":232241742,"pcpcounty":"","pcpid":"P0060162","pcpname":"VCUHS HAYES E WILLIS HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"4708 LINDLAW AVENUE  ","madd2":"","madd3":"","mcity":"RICHMOND ","mstate":"VA","mzip":"23234-3125","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F41.9","R63.4","M54.5","M54.6","F32.9","E03.9","G20","N32.81","I11.0","I50.30","G25.0","J45.909","G43.909","M54.9","Z91.81","Z79.899","Z12.31","R25.1","R51","N39.41","H40.1133","Z96.1","I50.9","K08.89","E78.5","Z00.00","N28.1","G25.2","I10","H40.1132","D61.818","D64.9","E87.6","E87.1","H40.1134","F33.0","G31.84","H17.821","H40.9","H55.89","J44.9","K08.409","K21.9","M25.60","M47.816","R26.81","R29.3","R29.898","R32","Z68.27","R06.02","F41.8","F41.1","E78.00","R06.00","G24.01","M19.90","G40.909","F39","F03.90","E07.9","Z79.890","Z86.73","R06.09","R25.8","R25.9","I95.9","R63.0","R26.9","H40.1130","E86.9","I49.3","R79.89","R41.82","W18.39XA","Y93.89","Y92.89","Y99.8","G92","M62.82","F02.80","I49.1","I51.7","R41.0","R00.0","F99","G93.40","R53.1","W19.XXXA","I27.20","G62.9","L89.311","S91.101D","Z91.14","M85.9","Z23","M85.80","J43.9","D72.819","D70.9","R91.8","R93.89","H40.1131","M25.561","M17.11","M25.761","M81.0","R51.9","W18.30XA","S06.9X9A","Z04.3","I49.8","E86.0","R53.81","F03.91","R56.9","R26.2","M62.81","B35.1","L85.3","G40.89","R55","Y92.009","G45.9","E86.1","E87.8","R35.0","Z71.89","R91.1","K57.30","M50.30","R26.89","W19.XXXS","S40.211S","M25.551","M25.511","T07.XXXA","R29.6","K59.00","N39.0","R94.31","S19.9XXA","S09.90XA","I07.1","I87.8","I25.3","M51.34","M47.814","M40.204","M43.8X4","S39.92XA","M51.36","M43.8X6","M53.3","M16.0","W01.0XXA","R62.7","E46","I50.32","F33.8","R41.841","Z03.818","M47.817","F32.A","F34.1","Z74.3"],"date":["2021-11-10","2021-06-21","2021-06-23","2021-06-23","2021-09-29","2021-11-15","2021-11-15","2021-10-01","2020-07-20","2021-11-10","2021-10-04","2021-11-15","2020-06-12","2021-06-23","2021-10-01","2021-08-05","2021-04-06","2021-06-10","2020-09-11","2021-08-13","2019-01-23","2021-02-19","2021-08-13","2018-02-07","2021-10-01","2018-12-20","2021-11-10","2019-10-28","2021-11-11","2020-02-07","2021-11-10","2021-10-19","2019-10-28","2021-08-01","2020-03-06","2018-03-14","2018-07-12","2018-03-14","2021-08-01","2018-03-14","2021-08-06","2018-03-14","2021-11-10","2018-03-14","2021-09-24","2018-03-14","2018-03-14","2018-03-14","2018-03-14","2018-03-14","2019-04-04","2021-10-25","2020-06-12","2021-11-10","2019-05-28","2019-07-07","2021-10-01","2021-07-02","2021-11-10","2021-10-01","2021-06-23","2021-06-23","2021-06-23","2019-07-07","2019-07-07","2019-07-07","2021-11-15","2019-07-09","2018-07-12","2020-07-14","2018-09-05","2018-09-05","2018-09-05","2021-11-15","2018-09-06","2018-09-06","2018-09-06","2018-09-06","2018-09-06","2021-08-01","2021-07-02","2018-09-05","2021-11-15","2021-08-04","2018-09-05","2018-09-06","2018-09-11","2018-09-07","2021-09-23","2018-09-11","2018-09-11","2018-09-11","2018-09-11","2018-09-11","2019-09-18","2019-10-28","2019-10-28","2019-11-18","2020-11-30","2020-11-30","2019-12-23","2019-12-23","2021-02-19","2021-06-10","2021-11-15","2021-05-17","2021-05-17","2021-10-04","2021-09-23","2021-06-23","2021-07-02","2021-07-02","2021-07-09","2021-07-09","2021-08-01","2021-08-01","2021-08-01","2021-10-01","2021-08-01","2021-08-01","2021-10-01","2021-10-01","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-08-04","2021-06-21","2021-07-02","2021-07-02","2021-07-02","2021-07-12","2021-07-12","2021-07-12","2021-07-02","2021-07-02","2021-07-02","2021-07-09","2021-07-14","2021-08-05","2021-09-23","2021-09-23","2021-09-23","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-09-27","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-09-23","2021-09-24","2021-09-24","2021-11-15","2021-10-01","2021-10-01","2021-10-01","2021-09-27","2021-11-15","2021-10-19","2021-11-15"],"priorHcc":[null,"","","",null,null,null,null,"",null,null,null,"","",null,"","","","","","","","","",null,"",null,"",null,"",null,null,"","","","","","","","","","",null,"","","","","","","","",null,"",null,"","",null,"",null,null,"","","","","","",null,"","","","","","",null,"","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","",null,"","",null,"","","","","","","","","",null,"","",null,null,"","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","",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":[["","378456177","POT CHLORIDE","TAB 10MEQ ER","","Select","Select",""],["","378395277","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","832712411","DIVALPROEX","TAB 500MG DR","","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","69097012303","TOPIRAMATE","TAB 50MG","","Select","Select",""],["","469260230","MYRBETRIQ","TAB 50MG","","Select","Select",""],["","24208041115","BRIMONIDINE","SOL 0.2% OP","","Select","Select",""],["","378180910","LEVOTHYROXIN","TAB 100MCG","","Select","Select",""],["","24208046325","LATANOPROST","SOL 0.00005","","Select","Select",""],["","228253910","CARB\/LEVO","TAB 25-100MG","","Select","Select",""],["","65862001330","SERTRALINE","TAB 100MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","50742061510","METOPROL SUC","TAB 25MG ER","","Select","Select",""],["","55111012960","RANITIDINE","CAP 150MG","","Select","Select",""],["","173071820","FLOVENT HFA","AER 44MCG","","Select","Select",""],["","57237000830","MIRTAZAPINE","TAB 15MG","","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","69315013701","BENZTROPINE","TAB 1MG","","Select","Select",""],["","310737220","BUDES\/FORMOT","AER 80-4.5","","Select","Select",""],["","66758016005","KLOR-CON 10","TAB 10MEQ ER","","Select","Select",""],["","378827052","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","832712411","DIVALPROEX ","TAB 500MG DR","270","Select","Select",""],["","378395277","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","57664049983","MIRTAZAPINE ","TAB 15MG","45","Select","Select",""],["","61314054701","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","17478071510","BRIMONIDINE ","SOL 0.2% OP","15","Select","Select",""],["","378456177","POT  CHLORIDE","TAB 10MEQ ER","360","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","50742061510","METOPROL ","TAB 25MG ER","45","Select","Select",""],["","69097012303","TOPIRAMATE ","TAB 50MG","180","Select","Select",""],["","469260230","MYRBETRIQ ","TAB 50MG","90","Select","Select",""],["","65862001330","SERTRALINE ","TAB 100MG","90","Select","Select",""],["","68180096901","LEVOTHYROXIN ","TAB 100MCG","90","Select","Select",""],["","228253910","CARB\/LEVO ","TAB 25-100MG","810","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","90","Select","Select",""],["","69315013701","BENZTROPINE ","TAB 1MG","60","Select","Select",""],["","66758016005","KLOR-CON ","TAB 10MEQ ER","360","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","55111012960","RANITIDINE ","CAP 150MG","90","Select","Select",""],["","310737220","BUDES\/FORMOT ","AER 80-4.5","10.2","Select","Select",""],["","173071820","FLOVENT ","AER 44MCG","10.6","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","500","Select","Select",""],["","378827052","ALBUTEROL ","NEB 0.00083","150","Select","Select",""],["","53746054401","PRIMIDONE ","50MG","60","Select","Select",""],["","50742061510","METOPROL","25MG ER","45","Select","Select",""],["","66758016005","KLOR-CON","10MEQ ER","360","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","00143992701","CIPROFLOXACN","250MG","10","Select","Select",""],["","53746054401","PRIMIDONE","50MG","60","Select","Select",""],["","00173071820","FLOVENT","44MCG","10.6","Select","Select",""],["","65162083366","DICLOFENAC","0.01","500","Select","Select",""],["","00173085910","BREO","100-25","60","Select","Select",""],["","00173085910","BREO ","INH 100-25","60","Select","Select",""],["","00143992701","CIPROFLOXACN ","TAB 250MG","10","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":""}]}]}