{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY A BYNUM","gend":1,"add":"4019 NORTH AVE APT 4","city":"RICHMOND","state":"VA","zip":"23219-1901","dob":"1952-01-08","age":"","mstatus":"","insh":11001424,"cliId":"3PJ2NA0FX04","pno":8042471663,"cno":"","email":"","ename":"","eno":"","pphy":"SELBY-PENCZAK, RACHEL","ppno":8043548108,"pcpadd":"401 N 11th St","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232191901,"pcpcounty":"","pcpid":"P9059174","pcpname":"VCU HEALTH GERIATRIC CONTINUUM SVCS","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"3916 Elberon Court","madd2":"Apt A","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23222-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M54.31","Z47.1","M43.16","Z96.641","M48.061","M48.07","M51.16","M51.36","M54.5","M48.062","I10","I11.0","Z12.31","Z23","E78.00","Z68.33","K21.0","M17.11","S39.012A","M54.41","V49.50XA","M54.9","V49.59XA","Y92.410","I25.10","J44.9","F17.200","M16.0","M25.462","M17.12","M16.11","M25.562","M16.10","I50.32","Z68.32","E66.9","F17.210","K08.409","K21.9","M15.9","Z79.82","Z79.899","Z00.00","I51.9","Z68.31","D64.9","I50.31","M54.42","M54.16","M25.561","M17.10","Z01.810","Z01.818","R94.31","I51.7","E78.5","R26.89","M76.891","M70.61","M79.604","I11.9","Z99.89","H25.11","Z79.51","R35.1","M19.90","Z68.29"],"date":["2020-01-13","2020-01-02","2020-01-24","2020-01-02","2020-01-13","2020-01-13","2020-01-13","2020-01-24","2020-02-25","2020-01-24","2019-08-15","2019-06-24","2019-05-16","2018-10-01","2018-10-01","2018-07-31","2018-10-01","2019-08-15","2019-04-03","2019-04-03","2019-04-03","2019-04-03","2019-04-03","2019-04-03","2020-02-25","2020-02-25","2019-06-24","2018-04-16","2018-04-16","2019-08-15","2019-08-12","2019-08-15","2019-08-15","2019-06-24","2019-04-16","2019-08-12","2020-02-25","2018-04-25","2020-02-25","2019-06-24","2020-02-25","2019-08-01","2020-06-29","2018-10-01","2019-08-12","2019-06-24","2019-08-15","2019-06-24","2020-06-29","2019-08-15","2019-08-15","2019-08-01","2019-08-01","2019-08-01","2019-08-01","2020-02-25","2019-08-15","2019-11-27","2019-11-27","2019-12-09","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2020-02-25"],"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":[["","93720198","PRAVASTATIN","TAB 20MG","","Select","Select",""],["","31722052101","HYDRALAZINE","TAB 50MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","68180037703","LOSARTAN POT","TAB 50MG","","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","173085910","BREO ELLIPTA","INH 100-25","","Select","Select",""],["","55111068305","IBU","TAB 600MG","","Select","Select",""],["","378363205","CARVEDILOL","TAB 6.25MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","42806000501","OXYCODONE","TAB 5MG","","Select","Select",""],["","29300016815","TIZANIDINE","TAB 2MG","","Select","Select",""],["","406012401","HYDROCO\/APAP","TAB 7.5-325","","Select","Select",""],["","65862076890","FENOFIBRATE","TAB 48MG","","Select","Select",""],["","49281040565","FLUZONE HD","INJ PF 19-20","","Select","Select",""],["","31722053301","METHOCARBAM","TAB 500MG","","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","","Select","Select",""],["","6483703","PNEUMOVAX 23","INJ 25\/0.5","","Select","Select",""],["","5197102","PREVNAR 13","INJ ","","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","","Select","Select",""],["","93101042","MUPIROCIN","OIN 0.02","","Select","Select",""],["","173085910","BREO ","INH 100-25","60","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","93720198","PRAVASTATIN ","TAB 20MG","90","Select","Select",""],["","31722052101","HYDRALAZINE ","TAB 50MG","270","Select","Select",""],["","378363205","CARVEDILOL ","TAB 6.25MG","180","Select","Select",""],["","68180037703","LOSARTAN ","TAB 50MG","90","Select","Select",""],["","68462039710","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","65862076890","FENOFIBRATE ","TAB 48MG","90","Select","Select",""],["","55111068305","IBU ","TAB 600MG","60","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","406012401","HYDROCO\/APAP ","TAB 7.5-325","30","Select","Select",""],["","42806000501","OXYCODONE ","TAB 5MG","42","Select","Select",""],["","69097015807","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","29300016815","TIZANIDINE ","TAB 2MG","20","Select","Select",""],["","49281012065","FLUZONE ","INJ PF 20-21","0.7","Select","Select",""],["","6483703","PNEUMOVAX ","INJ 25\/0.5","0.5","Select","Select",""],["","31722053301","METHOCARBAM ","TAB 500MG","30","Select","Select",""],["","5197102","PREVNAR ","INJ ","0.5","Select","Select",""],["","93101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","90","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":""}]}]}