{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLYDE W EPPS","gend":0,"add":"550 COLDFIELD ROAD","city":"MIDLOTHIAN","state":"VA","zip":"23114-9998","dob":"1976-09-11","age":"","mstatus":"","insh":11001847,"cliId":"2TD2FH4QU86","pno":7759108174,"cno":8047210130,"email":"","ename":"","eno":"","pphy":"BELTRAN-KEELING, JOYCE ","ppno":8045608920,"pcpadd":"611 Watkins Centre Pkwy Ste 250, ","pcpcity":"Midlothian","pcpstate":"VA","pcpzip":231144404,"pcpcounty":"","pcpid":"P0114247","pcpname":"INTERNAL MEDICINE ASSOCIATES OF CHESTERFIELD","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"N","ano":"","add2":"APT 128","add3":"","madd1":"4046 Chippendale Ct ","madd2":"","madd3":"","mcity":"North Chesterfield","mstate":"VA","mzip":"23234-3206","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["H00.015","H57.12","I10","F17.210","I81","K59.01","Z87.898","Z87.891","Z68.39","K21.9","M54.42","G89.29","Z68.41","K43.9","M54.5","E66.9","Z72.0","F14.90","R79.9","Z00.00","K80.12","N17.9","Z59.0","E87.6","F10.10","F14.10","Z81.8","Z83.3","I69.398","F25.9","H54.61","R10.84","K80.10","K80.20","K85.90","R07.89","R10.13","F19.10","I25.41","K81.0","Z68.34","R10.9","R10.11","K81.1","K91.89","L08.9","K91.870","Z79.01","R93.5","F29","Q24.8","Q24.9","Q24.5","Z68.33","R31.21","R31.9","D47.3","Z68.36","D59.0","H54.7","K08.409","I25.3","F41.9","K82.8","Z86.59","K60.2","R30.0","K64.9","E78.5","Z86.73","F81.9","Z79.84","H53.9","K59.09","M17.0","M47.9","E11.9","G89.4","K62.89"],"date":["2018-01-05","2018-01-05","2021-05-19","2020-10-19","2019-01-18","2019-01-18","2019-01-18","2021-08-09","2020-06-03","2020-10-19","2019-05-16","2020-06-03","2020-10-19","2020-06-03","2020-06-03","2020-10-19","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2018-06-06","2018-06-07","2018-06-06","2019-12-13","2018-06-18","2018-06-18","2018-06-06","2018-06-06","2018-06-06","2019-12-13","2018-06-06","2018-06-06","2018-06-14","2018-06-07","2019-12-13","2018-06-07","2018-06-12","2018-06-09","2018-06-09","2018-06-18","2018-07-26","2018-06-12","2018-06-13","2019-12-13","2018-06-17","2018-06-17","2018-06-17","2018-06-17","2018-09-27","2018-06-18","2018-06-18","2019-12-13","2018-09-19","2018-07-09","2019-07-11","2019-07-11","2019-12-13","2018-10-18","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2021-05-19","2021-09-13","2021-05-19","2021-05-19","2021-05-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2021-09-13"],"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":[["","68180052001","LISINOP\/HCTZ","TAB 20-25MG","","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","","Select","Select",""],["","832105410","BACLOFEN","TAB 10MG","","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","50458057930","XARELTO","TAB 20MG","","Select","Select",""],["","6027731","JANUVIA","TAB 100MG","","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","68382075810","METFORMIN ","TAB 500MG","180","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","180","Select","Select",""],["","68180052001","LISINOP\/HCTZ ","TAB 20-25MG","90","Select","Select",""],["","832105410","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","50458057930","XARELTO ","TAB 20MG","90","Select","Select",""],["","6027731","JANUVIA ","TAB 100MG","30","Select","Select",""],["","24658031205","DOXYCYCL ","TAB 100MG","14","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","62559043130","HYDROCORTISO ","CRE 0.025","30","Select","Select",""],["","16571020106","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","55111012705","CIPROFLOXACN ","500MG","10","Select","Select",""],["","69097084507","CYCLOBENZAPR ","5MG","42","Select","Select",""],["","62559043130","HYDROCORTISO","0.025","30","Select","Select",""],["","55111012705","CIPROFLOXACN","500MG","60","Select","Select",""],["","24658031205","DOXYCYCL","100MG","14","Select","Select",""],["","65162019050","NAPROXEN","500MG","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}