{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA M WILSON","gend":1,"add":"614 CHARLES AVE","city":"COLONIAL HEIGHTS  ","state":"VA","zip":"23834-9998","dob":"1966-08-25","age":"","mstatus":"","insh":11001844,"cliId":"2RF5AG3FF57","pno":8048052344,"cno":8048052344,"email":"","ename":"","eno":"","pphy":"HUOT, RACHEL","ppno":8046321030,"pcpadd":"1508 K V Rd","pcpcity":"Victoria ","pcpstate":"VA","pcpzip":239742624,"pcpcounty":"","pcpid":"P0124063","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES.","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"614 CHARLES AVE","madd2":"","madd3":"","mcity":"COLONIAL HEIGHTS  ","mstate":"VA","mzip":"23834-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["G40.909","F41.9","R56.9","F33.3","F43.12","F99","F06.31","E78.5","Z71.89","Z71.3","R09.82","B34.9","R94.31","S09.8XXA","R55","E87.6","E86.0","S09.90XA","R42","W19.XXXA","S19.9XXA","M50.321","R53.1","G93.89","F33.9","F33.1","R45.851","E87.1","Z79.899","S00.93XA","F44.5","F32.9","M19.90","E66.3","M17.12","M25.562","R41.0","R00.1","H53.8","Z12.31","Z12.4","Z00.00","Z12.39","Z12.11","R05","Z01.419","S92.515A","S92.515D","Z23","Z12.12","Z01.810","Z01.812","Z20.828","R41.82","S00.03XA","Z04.3","G89.18","R51","B37.3","Z47.1","Z96.652","M25.662","J40","J41.1","S63.611A","G40.89","M79.9","S09.93XA","R51.9","R22.0","W01.198A","S00.83XA","R40.2362","R40.2142","R40.2252","Z79.82","R25.1","W18.39XA","S52.502A","S53.22XA","S52.572A","S52.572D","R73.09","S01.01XA"],"date":["2021-10-18","2021-11-22","2021-11-22","2021-11-08","2021-11-08","2019-06-20","2019-03-15","2021-10-18","2021-10-18","2021-10-18","2019-02-13","2019-02-13","2019-03-09","2021-04-08","2019-07-14","2019-05-20","2019-03-09","2021-04-08","2019-03-13","2020-11-02","2019-03-09","2019-03-09","2019-03-09","2019-03-09","2019-03-12","2019-03-13","2019-03-13","2019-03-13","2019-03-13","2019-03-13","2021-04-08","2021-11-22","2021-11-22","2021-11-22","2020-12-08","2020-10-21","2019-04-22","2018-04-29","2018-04-29","2021-07-19","2019-05-28","2018-05-30","2019-09-23","2020-10-15","2020-06-24","2020-10-08","2020-10-01","2020-10-02","2021-10-18","2020-10-15","2020-10-30","2020-10-30","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-03","2018-11-09","2018-11-10","2020-12-31","2021-11-03","2020-12-31","2019-11-28","2020-11-27","2018-12-15","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-25","2021-04-25","2021-04-08","2021-08-02","2021-08-02","2021-08-03","2021-09-07","2021-10-18","2021-11-23"],"priorHcc":["",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":[["","68462013901","OXCARBAZEPIN","TAB 600MG","","Select","Select",""],["","68462035701","POT CHLORIDE","CAP 10MEQ ER","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","93101042","MUPIROCIN","OIN 0.02","","Select","Select",""],["","93720198","PRAVASTATIN","TAB 20MG","","Select","Select",""],["","406055201","OXYCODONE","TAB 5MG","","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","","Select","Select",""],["","143980305","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","33332031901","AFLURIA QUAD","INJ 2019-20","","Select","Select",""],["","62037099905","POT CL MICRO","TAB 20MEQ ER","","Select","Select",""],["","59746012206","MECLIZINE","TAB 12.5MG","","Select","Select",""],["","68382014114","TOPIRAMATE","TAB 200MG","","Select","Select",""],["","50111043302","TRAZODONE","TAB 50MG","","Select","Select",""],["","68462035701","POT  CHLORIDE","CAP 10MEQ ER","30","Select","Select",""],["","68462013901","OXCARBAZEPIN ","TAB 600MG","180","Select","Select",""],["","93101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","180","Select","Select",""],["","143980305","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","93720198","PRAVASTATIN ","TAB 20MG","90","Select","Select",""],["","406055201","OXYCODONE ","TAB 5MG","42","Select","Select",""],["","68382014114","TOPIRAMATE ","TAB 200MG","180","Select","Select",""],["","33332031901","AFLURIA ","INJ 2019-20","0.5","Select","Select",""],["","62037099905","POT  CL MICRO","TAB 20MEQ ER","10","Select","Select",""],["","59746012206","MECLIZINE ","TAB 12.5MG","15","Select","Select",""],["","50111043302","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","00143980305","DOXYCYCL","100MG","20","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","33332031901","AFLURIA","2019-20","0.5","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","30","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":""}]}]}