{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SANDY PAINTER","gend":0,"add":"10170 PURCELL RD  ","city":"HENRICO  ","state":"VA","zip":"23228-9998","dob":"1964-04-30","age":"","mstatus":"","insh":11002956,"cliId":"7G32EC7PP12","pno":8042724996,"cno":8042724996,"email":"","ename":"","eno":"","pphy":"HYDER, HAROON S","ppno":8047416200,"pcpadd":"9600 Patterson Ave Ste B","pcpcity":"Henrico  ","pcpstate":"VA","pcpzip":232296053,"pcpcounty":"","pcpid":"P0123810","pcpname":"BON SECOURS SENIOR CARE SERVICES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"10170 PURCELL RD  ","madd2":"","madd3":"","mcity":"HENRICO  ","mstate":"VA","mzip":"23228-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I48.91","J06.9","R03.0","Z68.30","I10","Z51.81","Z79.01","F33.1","F41.9","R05","J43.2","I71.2","E66.9","F17.200","N52.9","Z00.00","I35.0","I71.9","F17.210","F33.9","F41.1","G31.84","G44.1","G47.00","G62.9","G81.94","H02.403","I35.9","K08.409","M13.0","M47.812","M47.816","P11.2","R25.1","R42","R47.9","R62.50","R68.84","Z68.29","Z79.899","Z87.19","Z87.820","Z95.4","G60.9","I77.810","Z95.2","R52","M54.5","M70.62","N23","N20.0","F32.9","F12.10","E66.3","M19.019","M54.2","M25.551","M25.552","M70.61","Z68.28","H04.123","Z23","G43.809","J44.9","B97.89","E29.1","L30.9","W57.XXXA","R79.1","M25.561","M79.604","R22.41","S89.91XA","S80.11XA","S76.111A","S76.111D","Z72.0","I51.7","X50.1XXA","M19.90","M79.89","Z68.26","R60.0","I87.2","I48.20","G45.9"],"date":["2021-06-15","2019-09-24","2019-02-01","2019-04-22","2021-07-14","2018-06-13","2021-08-23","2019-11-11","2019-11-11","2019-03-08","2019-03-13","2021-06-15","2020-11-03","2021-05-08","2021-05-04","2020-09-21","2019-03-19","2019-03-19","2018-03-28","2018-03-28","2018-03-28","2018-03-28","2018-03-28","2021-05-04","2021-05-04","2018-03-28","2018-03-28","2018-03-28","2018-03-28","2018-03-28","2018-03-28","2019-04-22","2018-03-28","2018-03-28","2018-03-28","2018-03-28","2018-03-28","2018-03-28","2019-07-24","2021-05-08","2018-03-28","2018-03-28","2018-03-28","2021-05-24","2019-04-04","2021-07-14","2018-04-20","2019-09-11","2019-04-22","2019-05-06","2019-05-06","2018-07-23","2019-08-06","2019-07-24","2019-07-24","2019-07-24","2019-07-24","2019-09-03","2019-07-25","2021-05-04","2019-08-28","2020-09-21","2021-05-04","2021-05-08","2019-09-24","2021-05-04","2021-05-04","2020-11-17","2021-05-04","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2021-05-13","2021-05-27","2021-02-02","2021-02-10","2021-05-08","2021-05-08","2021-05-08","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2021-07-14"],"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":[["","65162076611","WARFARIN","TAB 5MG","","Select","Select",""],["","93506005","HYDROXYZ HCL","TAB 10MG","","Select","Select",""],["","13107003205","MIRTAZAPINE","TAB 45MG","","Select","Select",""],["","57664047752","METOPROL TAR","TAB 50MG","","Select","Select",""],["","68001041103","GABAPENTIN","TAB 600MG","","Select","Select",""],["","67877019810","AMLODIPINE","TAB 5MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","43598030488","TESTOSTERONE","GEL 0.0162","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","51672400301","NORTRIPTYLIN","CAP 50MG","","Select","Select",""],["","68382080610","TRAZODONE","TAB 100MG","","Select","Select",""],["","62332025050","DOXYCYC MONO","CAP 100MG","","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","","Select","Select",""],["","603459315","METHYLPRED","TAB 4MG","","Select","Select",""],["","591333130","BUPROPN HCL","TAB 150MG XL","","Select","Select",""],["","68382003410","VENLAFAXINE","CAP 37.5 ER","","Select","Select",""],["","43547040650","CLONAZEPAM","TAB 0.5MG","","Select","Select",""],["","168004160","BETAMETH VAL","LOT 0.001","","Select","Select",""],["","68001041103","GABAPENTIN ","TAB 600MG","240","Select","Select",""],["","67877019810","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","93172110","WARFARIN ","TAB 5MG","30","Select","Select",""],["","603254421","BUT\/APAP\/CAF ","TAB ","15","Select","Select",""],["","43598030488","TESTOSTERONE ","GEL 0.0162","75","Select","Select",""],["","93506005","HYDROXYZ ","TAB 10MG","90","Select","Select",""],["","13107003205","MIRTAZAPINE ","TAB 45MG","90","Select","Select",""],["","68382080605","TRAZODONE ","TAB 100MG","180","Select","Select",""],["","57664047752","METOPROL ","TAB 50MG","60","Select","Select",""],["","68180096301","ALBUTEROL ","AER HFA","8.5","Select","Select",""],["","168004160","BETAMETH ","LOT 0.001","60","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","62332025050","DOXYCYC ","CAP 100MG","14","Select","Select",""],["","406055201","OXYCODONE ","TAB 5MG","12","Select","Select",""],["","51672400301","NORTRIPTYLIN ","CAP 50MG","30","Select","Select",""],["","43547040650","CLONAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","40","Select","Select",""],["","68382003410","VENLAFAXINE ","CAP 37.5 ER","30","Select","Select",""],["","603459315","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","591333130","BUPROPN ","150MG XL","90","Select","Select",""],["","68382005105","MELOXICAM ","15MG","15","Select","Select",""],["","68001036700","POT  CHLORIDE","10MEQ ER","30","Select","Select",""],["","42799011901","BUMETANIDE ","0.5MG","30","Select","Select",""],["","00093506005","HYDROXYZ","10MG","90","Select","Select",""],["","57664047752","METOPROL","50MG","60","Select","Select",""],["","68180096301","ALBUTEROL","HFA","8.5","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","00406055201","OXYCODONE","5MG","12","Select","Select",""],["","49884072703","DOXYCYC","100MG","20","Select","Select",""],["","00168004160","BETAMETH","0.001","60","Select","Select",""],["","42799011901","BUMETANIDE","0.5MG","30","Select","Select",""],["","68001036700","POT CHLORIDE","10MEQ ER","30","Select","Select",""],["","65162062711","TRAMADOL","50MG","40","Select","Select",""],["","00591333130","BUPROPN","150MG XL","90","Select","Select",""],["","68382005105","MELOXICAM","15MG","15","Select","Select",""],["","70461042110","FLUCLVX ","INJ 2021-22","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":[[["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":""}]}]}