{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID L ARTHUR JR","gend":0,"add":"4326 THREE BRIDGE RD","city":"POWHATAN","state":"VA","zip":"23139-9998","dob":"1966-11-24","age":"","mstatus":"","insh":11002846,"cliId":"5EJ0NA7MC07","pno":8045987335,"cno":8042550458,"email":"","ename":"","eno":"","pphy":"JOSEPH, SHARON E","ppno":8042856050,"pcpadd":"6372 Mechanicsville Tpke Ste 103, ","pcpcity":"Mechanicsville","pcpstate":"VA","pcpzip":231114710,"pcpcounty":"","pcpid":"P0060023","pcpname":"ST FRANCIS FAMILY MEDICINE CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"4326 THREE BRIDGE RD","madd2":"","madd3":"","mcity":"POWHATAN","mstate":"VA","mzip":"23139-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E11.9","F31.30","I10","E78.00","E55.9","Z68.35","G44.221","E78.2","Z68.36","M79.609","F33.2","E11.65","F51.05","K57.32","R10.9","Z79.4","Z79.899","Z87.891","K57.92","Z12.11","Z68.37","N40.0","R39.11","R39.198","R33.9","Z13.0","H61.21","E66.01","Z12.5","R35.1","H25.13","H52.7","Z00.00","E78.5","F31.9","G47.30","H61.22","M13.161","M13.162","N39.9","R35.0","Z79.82","Z91.19","D12.0","D12.2","D12.3","H65.111","J02.9","H92.01","R59.9","H61.23","Z97.3","Z87.19","Z86.010","M13.122","M13.141","M13.142","Z23","E03.9"],"date":["2021-03-15","2020-03-30","2021-05-19","2021-05-19","2021-05-19","2020-10-07","2019-12-09","2019-12-09","2021-05-19","2020-03-09","2021-04-27","2021-05-19","2020-03-30","2018-04-13","2018-06-26","2019-12-09","2018-07-11","2019-12-09","2018-06-26","2021-03-15","2018-07-11","2020-06-10","2019-05-21","2019-05-21","2019-05-21","2020-10-07","2020-06-10","2019-07-08","2018-06-20","2018-06-20","2018-06-22","2018-06-22","2020-10-07","2018-07-11","2018-07-11","2018-07-11","2018-07-11","2019-12-09","2018-07-11","2018-07-11","2018-07-11","2018-07-11","2018-07-11","2018-08-07","2018-08-07","2018-08-07","2018-12-20","2018-12-07","2018-12-07","2018-12-07","2019-12-09","2019-12-09","2019-12-09","2019-12-09","2019-12-09","2019-12-09","2019-12-09","2020-10-07","2021-05-19"],"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":[["","8290320119","BD PEN NEEDL","MIS 31GX5MM","","Select","Select",""],["","8222710048","PEN NEEDLES","MIS 31GX6MM","","Select","Select",""],["","68180036309","FENOFIBRATE","TAB 160MG","","Select","Select",""],["","99073070822","FREESTYLE","TES LITE","","Select","Select",""],["","58160081912","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","65862020190","LOSARTAN POT","TAB 25MG","","Select","Select",""],["","68382076010","METFORMIN","TAB 1000MG","","Select","Select",""],["","88221905","LANTUS SOLOS","INJ 100\/ML","","Select","Select",""],["","70377003012","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","169406013","VICTOZA","INJ 18MG\/3ML","","Select","Select",""],["","43547034106","RISPERIDONE","TAB 1MG","","Select","Select",""],["","55111032101","GLIMEPIRIDE","TAB 2MG","","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","","Select","Select",""],["","70461031903","FLUCLVX QUAD","INJ 2019-20","","Select","Select",""],["","5197102","PREVNAR 13","INJ ","","Select","Select",""],["","49281042050","FLUZONE QUAD","INJ 2020-21","","Select","Select",""],["","8222710048","PEN  NEEDLES  ","MIS 31GX6MM","100","Select","Select",""],["","8290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","TES LITE","50","Select","Select",""],["","58160081912","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","65862020190","LOSARTAN ","TAB 25MG","90","Select","Select",""],["","68382076010","METFORMIN ","TAB 1000MG","180","Select","Select",""],["","88221905","LANTUS ","INJ 100\/ML","30","Select","Select",""],["","68180036309","FENOFIBRATE ","TAB 160MG","90","Select","Select",""],["","43547034206","RISPERIDONE ","TAB 2MG","180","Select","Select",""],["","69097084507","CYCLOBENZAPR ","TAB 5MG","30","Select","Select",""],["","55111032101","GLIMEPIRIDE ","TAB 2MG","180","Select","Select",""],["","70377003012","ATORVASTATIN ","TAB 80MG","90","Select","Select",""],["","169406013","VICTOZA ","INJ 18MG\/3ML","27","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","5197102","PREVNAR ","INJ ","0.5","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","70461031903","FLUCLVX ","INJ 2019-20","0.5","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","",""],["Yes","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":""}]}]}