{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAMELA S FELDER","gend":1,"add":"205 S MAIN ST. APT 8 ","city":"LAWRENCEVILLE  ","state":"VA","zip":"23868-9998","dob":"1962-02-15","age":"","mstatus":"","insh":11003757,"cliId":"2QW3E36GC97","pno":4346238437,"cno":4346238437,"email":"","ename":"","eno":"","pphy":"PINSON, ANDY G ","ppno":8048288786,"pcpadd":"417 N 11th St","pcpcity":"Richmond ","pcpstate":"VA","pcpzip":232985002,"pcpcounty":"","pcpid":"P9059171","pcpname":"VCUHS AD WILLIAMS CLINIC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"67 Piney Woods Rd ","madd2":"","madd3":"","mcity":"Lawrenceville  ","mstate":"VA","mzip":"23868-2713","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["K58.0","N39.3","N20.0","R93.421","K76.0","Z48.816","Z87.442","E11.65","I10","F43.21","B37.9","E66.9","E11.42","E11.21","M25.572","F41.8","L29.0","Z79.4","E11.9","R51","Z13.9","E78.5","Z23","E03.9","M54.2","M25.561","R00.0","E11.00","Z98.890","T81.89XA","R10.9","F32.9","F41.9","E11.40","M54.6","E66.01","G47.00","M77.41","M79.671","E10.9","M19.90","Z12.31","I51.7","I50.30","I83.813","G89.29","M17.0","G57.61","I20.9","R06.02","R10.31","Z90.49","D25.9","I87.2","N20.2","Z01.812","M77.31","M79.673","Z46.6","D64.9","Z68.38","E55.9","Z88.5","E11.10","M19.071","M19.072","M77.32","M77.52","N36.5","Z96.0","Z01.818","F43.20","Z79.84","M54.9","M79.672","Z79.899","N31.9","K44.9","N95.0","Z68.41","B37.3","N39.0","R10.2","Z88.8","M79.7","A60.9","G90.09","R60.0","U07.1","K52.9","Z11.59","Z86.010","K64.8","R11.2","R19.7","E78.00","R10.13","N89.8","R11.0","R30.0","Z11.3","G44.209","N93.9","Z32.02","Z01.411","Z11.51","Z12.4","D25.1","Z59.6","M79.642","I11.0"],"date":["2021-11-24","2021-11-24","2020-01-16","2020-01-16","2020-01-16","2020-01-16","2020-01-16","2021-05-11","2021-10-13","2020-02-11","2020-01-24","2020-02-11","2019-05-17","2019-01-25","2019-01-25","2021-01-29","2019-01-25","2021-09-10","2021-10-13","2020-02-11","2021-05-11","2020-09-02","2021-01-18","2020-03-17","2021-01-18","2020-03-17","2020-04-27","2020-04-27","2018-05-01","2018-05-08","2019-05-17","2021-09-10","2021-09-10","2021-09-10","2018-06-08","2021-05-11","2018-06-08","2020-11-09","2021-05-11","2020-07-14","2020-06-24","2021-10-27","2020-07-09","2020-07-09","2020-07-09","2019-11-08","2018-07-13","2020-07-14","2020-07-21","2020-09-02","2019-11-01","2021-10-13","2021-07-16","2020-09-02","2019-10-11","2021-03-02","2020-10-19","2020-10-03","2019-11-08","2019-11-08","2019-10-11","2019-10-11","2019-11-08","2018-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2019-10-23","2019-10-23","2019-11-01","2019-11-01","2019-11-01","2021-01-18","2020-11-06","2021-09-10","2019-11-08","2019-11-08","2021-07-16","2019-11-08","2021-05-11","2021-03-10","2019-11-18","2019-11-18","2019-11-18","2019-11-19","2020-11-24","2020-11-24","2020-12-14","2021-03-10","2021-03-02","2021-03-04","2021-03-04","2021-06-08","2021-06-08","2021-10-13","2021-03-10","2021-09-10","2021-04-20","2021-04-26","2021-05-11","2021-05-21","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-07-16","2021-09-10","2021-10-13","2021-11-02"],"priorHcc":[null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","27241009903","DULOXETINE","CAP 60MG","","Select","Select",""],["","57599000101","FREESTYLE","KIT SENSOR","","Select","Select",""],["","169406012","VICTOZA","INJ 18MG\/3ML","","Select","Select",""],["","60505257909","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","31722072990","IRBESARTAN","TAB 75MG","","Select","Select",""],["","64980032430","PROCTOZONE","CRE -HC 2.5%","","Select","Select",""],["","17478071110","LIDOCAINE","GEL 2% JELLY","","Select","Select",""],["","56151146004","TRUE METRIX","TES GLUCOSE","","Select","Select",""],["","23155050101","HYDROXYZ HCL","TAB 25MG","","Select","Select",""],["","71101468","LYRICA","CAP 75MG","","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","","Select","Select",""],["","55111015901","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","8290320550","BD PEN NEEDL","MIS 32GX5\/32","","Select","Select",""],["","88221905","LANTUS SOLOS","INJ 100\/ML","","Select","Select",""],["","69238131709","PREGABALIN","CAP 300MG","","Select","Select",""],["","65862019105","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","","Select","Select",""],["","56151014701","TRUPLUS LANC","MIS 33G","","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","","Select","Select",""],["","65162062710","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","65162018910","NAPROXEN","TAB 375MG","","Select","Select",""],["","65862059801","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","172572860","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","10702020101","OXYBUTYNIN","TAB 5MG","","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","","Select","Select",""],["","169633910","NOVOLOG","INJ FLEXPEN","","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","","Select","Select",""],["","58160089652","FLUARIX QUAD","INJ 2019-20","","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","","Select","Select",""],["","45802006335","TRIAMCINOLON","CRE 0.00025","","Select","Select",""],["","23155050101","HYDROXYZ ","TAB 25MG","90","Select","Select",""],["","168034646","TERCONAZOLE ","CRE 0.004","45","Select","Select",""],["","65162027210","SMZ\/TMP ","TAB 800-160","6","Select","Select",""],["","64980032430","PROCTOZONE ","CRE -HC 2.5%","30","Select","Select",""],["","169406013","VICTOZA ","INJ 18MG\/3ML","27","Select","Select",""],["","88221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","60505257909","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","27241009903","DULOXETINE ","CAP 60MG","90","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","17478071110","LIDOCAINE ","GEL 2% JELLY","30","Select","Select",""],["","31722072990","IRBESARTAN ","TAB 75MG","90","Select","Select",""],["","8290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","71101468","LYRICA ","CAP 75MG","180","Select","Select",""],["","56151146004","TRUE ","TES GLUCOSE","50","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","31722070530","VALACYCLOVIR ","TAB 1GM","20","Select","Select",""],["","69238131709","PREGABALIN ","CAP 300MG","60","Select","Select",""],["","55111015901","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","500","Select","Select",""],["","65162018910","NAPROXEN ","TAB 375MG","60","Select","Select",""],["","65862019105","CYCLOBENZAPR ","TAB 10MG","60","Select","Select",""],["","56151014701","TRUPLUS ","MIS 33G","100","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","90","Select","Select",""],["","169633910","NOVOLOG ","INJ FLEXPEN","9","Select","Select",""],["","65162074510","PROMETHAZINE ","TAB 12.5MG","21","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","57599157904","FREESTYLE    TES PREC NEO","TES PREC NEO","100","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","58160084252","BOOSTRIX ","INJ ","0.5","Select","Select",""],["","58160089652","FLUARIX ","INJ 2019-20","0.5","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","6","Select","Select",""],["","65162047810","NITROFURANTN ","100MG","14","Select","Select",""],["","65162062710","TRAMADOL ","50MG","6","Select","Select",""],["","65862059801","TAMSULOSIN ","0.4MG","30","Select","Select",""],["","10702020101","OXYBUTYNIN ","5MG","63","Select","Select",""],["","45802006335","TRIAMCINOLON ","0.03%","30","Select","Select",""],["","65162027210","SMZ\/TMP","800-160","6","Select","Select",""],["","23155050101","HYDROXYZ","25MG","90","Select","Select",""],["","00168034646","TERCONAZOLE","0.004","45","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","56151014701","TRUPLUS","33G","100","Select","Select",""],["","56151146001","TRUE","GLUCOSE","100","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","6","Select","Select",""],["","00002143380","TRULICITY","0.75\/0.5","2","Select","Select",""],["","57599157904","FREESTYLE TES PREC NEO","PREC NEO","100","Select","Select",""],["","58160089652","FLUARIX","2019-20","0.5","Select","Select",""],["","65162062710","TRAMADOL","50MG","6","Select","Select",""],["","00002143380","TRULICITY ","INJ 0.75\/0.5","2","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":""}]}]}