{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VICTOR A ALFORD","gend":0,"add":"6931 MERRIEWOOD RIDGE DRIVE","city":"RICHMOND ","state":"VA","zip":"23237-9998","dob":"1987-04-02","age":"","mstatus":"","insh":11002514,"cliId":"5FX5PT9EG62","pno":8043097876,"cno":8048036611,"email":"","ename":"","eno":"","pphy":"GONZALEZ, ANDREA","ppno":8044201300,"pcpadd":",","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232242078,"pcpcounty":"","pcpid":"P9059080","pcpname":"SOUTH SIDE MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"6931 MERRIEWOOD RIDGE DRIVE","madd2":"","madd3":"","mcity":"RICHMOND ","mstate":"VA","mzip":"23237-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["H52.03","H52.223","F31.89","M54.5","G89.29","Z11.3","L91.0","M79.602","L08.9","W57.XXXA","R59.9","F17.200","S10.96XA","E66.3","F17.210","F31.9","G31.84","R29.2","Z68.32","Z79.899","Z20.828","L05.01","L73.1","F31.81","B35.3","M79.671","S76.312A","S79.922A","X58.XXXA","Y93.02"],"date":["2018-01-16","2018-01-16","2019-02-01","2018-11-09","2018-02-06","2018-02-06","2019-10-30","2019-04-10","2020-05-30","2020-05-30","2020-05-30","2021-07-17","2020-05-30","2018-07-31","2018-07-31","2018-07-31","2018-07-31","2018-07-31","2018-07-31","2021-05-25","2020-08-20","2018-10-30","2019-10-30","2018-11-09","2021-05-25","2021-05-25","2021-07-17","2021-07-17","2021-07-17","2021-07-17"],"priorHcc":["","","","","","","","","","","",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":[["","65162062711","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","93310905","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","51991029301","OXCARBAZEPIN","TAB 300MG","","Select","Select",""],["","93206301","QUETIAPINE","TAB 25MG","","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","168020230","CLINDAMYCIN","GEL 0.01","","Select","Select",""],["","378808645","TRETINOIN","GEL 0.00025","","Select","Select",""],["","378808645","TRETINOIN ","GEL 0.00025","45","Select","Select",""],["","93310905","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","10","Select","Select",""],["","93206301","QUETIAPINE ","TAB 25MG","60","Select","Select",""],["","51991029301","OXCARBAZEPIN ","TAB 300MG","60","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","168020230","CLINDAMYCIN ","GEL 0.01","30","Select","Select",""],["","67877021901","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","51672127502","CLOTRIMAZOLE ","1%","30","Select","Select",""],["","65162019010","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 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":[[["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":""}]}]}