{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RONZA T JOHNSON","gend":1,"add":"6305 PHOBUS CT ","city":"NORTH CHESTERFIELD","state":"VA","zip":"23234-9998","dob":"1964-12-24","age":"","mstatus":"","insh":11003752,"cliId":"9X90XK2VX16","pno":8049724657,"cno":8049399806,"email":"","ename":"","eno":"","pphy":"JACKSON, RICHARD A","ppno":8042257148,"pcpadd":"304 E Leigh St","pcpcity":"Richmond ","pcpstate":"VA","pcpzip":232191410,"pcpcounty":"","pcpid":"P0124311","pcpname":"DOMINION MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"6305 PHOBUS CT ","madd2":"","madd3":"","mcity":"NORTH CHESTERFIELD","mstate":"VA","mzip":"23234-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z79.891","G89.4","M48.12","M54.2","M62.838","G24.3","R23.3","E55.9","H93.299","H53.8","I10","M54.5","R79.9","Z09","E53.8","R53.1","R63.4","R70.0","D68.9","M06.80","L93.0","I11.9","E11.9","E03.9","E78.5","G24.8","Z12.31","E66.9","Z00.00","R06.02","Z79.899","M47.812","M79.18","F17.200","G89.29","M15.9","R00.0","R50.81","R52","R05","R50.9","R68.89","Z79.1","Z88.5","R53.83","R11.0","R09.81","R51","M71.21","R94.31","R79.89","Z92.29","K21.9","Z68.41","R89.9","M81.0","E66.01"],"date":["2021-10-12","2021-03-15","2021-10-12","2021-09-21","2021-08-27","2021-10-12","2018-07-26","2021-09-21","2021-03-09","2021-03-09","2021-09-21","2018-11-14","2021-09-21","2018-11-14","2021-09-21","2018-11-14","2018-11-14","2018-07-30","2018-07-30","2018-07-30","2018-07-30","2021-03-09","2019-10-24","2021-09-21","2021-09-21","2021-08-27","2018-10-25","2019-11-11","2021-03-09","2021-06-14","2021-10-12","2018-12-06","2018-12-06","2021-03-09","2021-06-14","2018-12-18","2020-03-01","2020-03-01","2020-03-01","2020-03-01","2020-03-01","2021-09-21","2020-03-01","2020-03-01","2020-03-01","2020-03-01","2020-03-01","2020-03-01","2019-05-13","2021-03-09","2021-09-21","2021-09-21","2021-09-21","2021-10-12","2021-09-21","2021-09-21","2021-10-12"],"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":[["","65162062711","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","74372790","SYNTHROID","TAB 137MCG","","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","","Select","Select",""],["","378395277","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","65162017850","METFORMIN","TAB 500MG ER","","Select","Select",""],["","68180051703","LISINOPRIL","TAB 40MG","","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","93031401","KETOROLAC","TAB 10MG","","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","","Select","Select",""],["","59651000205","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","69046903","CHANTIX","PAK 1MG","","Select","Select",""],["","59011041010","OXYCONTIN","TAB 10MG CR","","Select","Select",""],["","65862020399","LOSARTAN POT","TAB 100MG","","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","","Select","Select",""],["","69238183701","LEVOTHYROXIN","TAB 137MCG","","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","90","Select","Select",""],["","74372790","SYNTHROID ","TAB 137MCG","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","60","Select","Select",""],["","378395277","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","59651000205","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","65162017850","METFORMIN ","TAB 500MG ER","120","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","69046903","CHANTIX ","PAK 1MG","56","Select","Select",""],["","68180051703","LISINOPRIL ","TAB 40MG","90","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","93031401","KETOROLAC ","TAB 10MG","10","Select","Select",""],["","59011041010","OXYCONTIN ","TAB 10MG CR","21","Select","Select",""],["","65862020399","LOSARTAN ","TAB 100MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","90","Select","Select",""],["","69238183701","LEVOTHYROXIN ","TAB 137MCG","30","Select","Select",""],["","70010077005","METHOCARBAM ","TAB 750MG","90","Select","Select",""],["","69238126601","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","20","Select","Select",""],["","65162062711","TRAMADOL","50MG","90","Select","Select",""],["","65862020399","LOSARTAN","100MG","90","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":""}]}]}