{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BERNARD C BRANCH JR","gend":0,"add":"6117 BLILEY RD, ROOM 8  ","city":"RICHMOND ","state":"VA","zip":"23225-9998","dob":"1971-05-26","age":"","mstatus":"","insh":11002900,"cliId":"2UH3AY9VJ01","pno":7739092493,"cno":7739092493,"email":"","ename":"","eno":"","pphy":"JONES, SIDNEY RIVERS ","ppno":8042827857,"pcpadd":"7001 Forest Ave Ste 2500","pcpcity":"Richmond ","pcpstate":"VA","pcpzip":232301726,"pcpcounty":"","pcpid":"P9058394","pcpname":"BON SECOURS CANAL CROSSING INTERNAL MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"309   OAK GLEN STREET","add3":"","madd1":"309 OAK GLEN ST,  ","madd2":"309   OAK GLEN STREET","madd3":"","mcity":"RICHMOND ","mstate":"VA","mzip":"23225-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","E78.5","N18.9","R79.89","R73.9","Z68.35","Z23","Z68.36","Z51.81","H40.1131","H52.4","R56.9","Z86.69","Z87.820","Z12.5","Z00.00","Z13.31","E66.9","I12.9","N18.2","H40.1113","H40.1121","Z79.899","G40.009","G93.89","G40.209","Z20.822","Z87.828","Z86.79","Z11.59","Z78.9","Z12.11","Z01.812","K64.8","E78.00","E66.01","Z79.82"],"date":["2021-10-04","2021-10-04","2021-09-17","2021-04-21","2020-08-25","2021-09-17","2021-04-21","2021-10-04","2019-10-02","2021-06-23","2021-06-23","2020-10-21","2020-10-21","2021-09-17","2018-11-15","2021-10-04","2018-11-15","2020-01-13","2021-09-17","2020-01-13","2018-02-28","2018-02-28","2021-09-17","2019-05-15","2019-05-15","2020-01-16","2021-09-13","2021-03-09","2021-03-09","2021-04-21","2021-04-21","2021-09-17","2021-09-13","2021-09-17","2021-09-17","2021-10-04","2021-09-17"],"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":[["","61314054701","LATANOPROST","SOL 0.00005","","Select","Select",""],["","68382009501","CARVEDILOL","TAB 25MG","","Select","Select",""],["","378156001","PHENYTOIN EX","CAP 100MG","","Select","Select",""],["","378022201","CHLORTHALID","TAB 25MG","","Select","Select",""],["","31722088530","ROSUVASTATIN","TAB 40MG","","Select","Select",""],["","58160088552","FLUARIX QUAD","INJ 2020-21","","Select","Select",""],["","61314054701","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","378156001","PHENYTOIN ","CAP 100MG","90","Select","Select",""],["","31722088530","ROSUVASTATIN ","TAB 40MG","30","Select","Select",""],["","68382009501","CARVEDILOL ","TAB 25MG","60","Select","Select",""],["","378022201","CHLORTHALID ","TAB 25MG","30","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0.5","Select","Select",""],["","00378156001","PHENYTOIN","100MG","90","Select","Select",""],["","58160088552","FLUARIX","2020-21","0.5","Select","Select",""],["","52268020101","SUTAB","","24","Select","Select",""],["","52268020101","SUTAB ","TAB ","24","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","",""],["Yes","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":""}]}]}