{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOYCE B YOUNG","gend":1,"add":"717 ERIN CRESCENT STREET","city":"HENRICO  ","state":"VA","zip":"23231-1218","dob":"1951-05-13","age":"","mstatus":"","insh":11002645,"cliId":"6CM7CX2MW74","pno":8042442183,"cno":8042442183,"email":"","ename":"","eno":"","pphy":"MCKENZIE, JUDITH J","ppno":8047641253,"pcpadd":"8200 MEADOWBRIDGE ROAD,STE 306","pcpcity":"MECHANICSVILLE ","pcpstate":"VA","pcpzip":231162337,"pcpcounty":"HANOVER","pcpid":"P9443295","pcpname":"BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APARTMENT 1524 ","add3":"","madd1":"717 ERIN CRESCENT STREET","madd2":"APARTMENT 1524 ","madd3":"","mcity":"HENRICO  ","mstate":"VA","mzip":"23231-1218","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R22.32","I10","R94.31","C47.12","E66.9","Z68.41","G89.29","F17.200","C49.12","D36.12","Z47.89","M75.81","Z68.30","Z68.39","C80.1","K44.9","R22.9","C40.12","M79.642","F41.9","Z68.38","Z89.022","G89.18","Z12.31","C49.9","E07.89","J98.4","J98.11","R91.8","K80.20","Z08","Z85.831","M47.9","M10.072","F17.210","S46.091D","H25.13","H35.3110","M17.11","M17.12","R68.89","M25.642","M25.532","M25.632","Z47.81","M54.5","E66.01","Z86.010","E55.9","M10.9","R05","Z00.00","Z12.11","Z78.0","Z13.220","Z13.31","M06.9","K83.8","K57.30","K64.8","Z80.0","Z79.899","K57.90","K64.9","E04.1","E27.8","M25.551","Z68.37","M47.816","M51.26","M16.11","S68.722A","E04.2","Z01.818","M25.859","Z47.1","Z96.641","Z79.82","Z91.81","Z13.5","M79.89","R60.0","R22.30","R22.31","N20.0","J47.9","M25.561","Z68.35","S68.119D","M79.671","M79.672","Z11.59","R73.09"],"date":["2018-10-15","2021-09-24","2018-10-11","2018-10-15","2018-11-15","2018-10-15","2021-05-13","2018-10-15","2020-03-06","2018-10-30","2019-11-08","2019-11-01","2019-11-01","2019-11-26","2019-04-05","2020-07-17","2019-11-08","2019-08-01","2021-02-22","2018-11-15","2019-04-02","2020-07-17","2018-11-15","2021-11-23","2021-05-21","2020-11-20","2020-11-20","2020-11-20","2021-05-21","2020-11-20","2021-05-24","2021-05-24","2019-11-26","2019-11-26","2019-11-26","2019-11-26","2019-11-26","2019-11-26","2021-07-17","2019-11-26","2019-07-02","2019-09-03","2019-09-03","2019-09-03","2020-07-17","2021-05-13","2021-08-24","2019-01-25","2021-08-24","2019-08-01","2019-01-25","2021-08-24","2019-04-02","2019-02-07","2021-08-24","2021-08-24","2021-04-09","2020-03-06","2019-04-02","2019-04-02","2019-04-02","2019-04-02","2019-04-02","2019-04-02","2019-04-05","2019-04-05","2018-06-08","2018-07-16","2018-06-08","2018-06-08","2018-06-29","2019-06-28","2021-05-21","2018-07-16","2018-07-24","2018-07-25","2021-06-03","2018-07-25","2018-07-25","2019-08-01","2018-10-03","2018-09-08","2018-10-05","2018-09-28","2018-10-05","2021-05-21","2021-06-03","2021-02-22","2021-05-13","2021-05-13","2021-05-13","2021-08-24","2021-08-24"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","",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":[["","93314705","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","16729013516","ALLOPURINOL","TAB 300MG","","Select","Select",""],["","781577626","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","","Select","Select",""],["","54429931","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","","Select","Select",""],["","10572030201","PEG-3350\/KCL","SOL \/SODIUM","","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","54429931","FUROSEMIDE ","TAB 40MG","90","Select","Select",""],["","16729013516","ALLOPURINOL ","TAB 300MG","90","Select","Select",""],["","93314705","CEPHALEXIN ","CAP 500MG","2","Select","Select",""],["","781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","10572030201","PEG-3350\/KCL ","\/SODIUM","4,000.00","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":""}]}]}