{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PRECIOUS SAMUELS","gend":1,"add":"1601 LAKESIDE AVENUE ","city":"HENRICO  ","state":"VA","zip":"23228-9998","dob":"1992-03-06","age":"","mstatus":"","insh":11003918,"cliId":"7YT6VG9WV49","pno":8044428418,"cno":8045034535,"email":"","ename":"","eno":"","pphy":"GLADFELTER, BAMBI L  ","ppno":8042391640,"pcpadd":"12018 W Broad St Ste 100","pcpcity":"Henrico  ","pcpstate":"VA","pcpzip":232337796,"pcpcounty":"","pcpid":"P0114248","pcpname":"PRIMARY CARE OF WEST END LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT 304  ","add3":"","madd1":"1601 LAKESIDE AVENUE ","madd2":"APT 304  ","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":["R39.81","Q90.9","J20.9","R51","J45.909","F17.200","Z79.51","R05","R06.02","J06.9","Z68.31","J30.1","J45.30","F22","K13.79","K13.0","L98.8","H92.01","H61.21","Q21.2","Q24.4","I34.0","R20.2","Z77.098","J01.10","Z68.29","H66.002","J30.9","Z68.30","J32.9","M25.512","J40","Z87.09","B97.89","Z68.32","Z00.01","E66.3","J45.40","E03.8","N76.0","R32","E66.8","J30.89","Z12.4","R10.13","E03.9","G44.219","H04.129","Q25.72","R00.1","Z68.28","H10.12","Z20.828","Z11.59","H66.92","J45.901","R51.9","R53.81","Z77.22","Z20.822","R09.81","K59.00","S99.921A","V00.838A","J01.90","B96.89"],"date":["2021-11-08","2021-11-08","2019-02-27","2019-01-28","2021-07-23","2019-01-28","2021-07-23","2021-07-23","2021-02-02","2020-02-17","2021-07-13","2019-02-27","2019-02-27","2019-03-25","2019-03-25","2019-03-25","2019-03-25","2019-04-20","2019-04-20","2019-05-03","2019-05-03","2019-05-03","2019-05-08","2019-05-08","2019-06-12","2019-06-12","2019-07-28","2019-07-28","2019-07-28","2018-09-06","2019-10-12","2019-10-12","2019-10-12","2019-10-12","2019-10-12","2019-10-23","2018-10-22","2019-10-23","2018-10-22","2018-10-22","2019-10-23","2019-10-23","2019-10-23","2019-10-23","2019-10-23","2019-10-23","2019-10-23","2019-10-23","2018-10-25","2018-10-25","2018-10-25","2018-10-26","2020-12-08","2020-12-08","2018-12-12","2021-04-01","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-04-01","2021-07-23","2021-07-13","2021-07-13","2021-08-05","2021-08-05"],"priorHcc":[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":[["","60505082901","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","85461001","DULERA","AER 200-5MCG","","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","","Select","Select",""],["","781808926","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","33332032001","AFLURIA QUAD","INJ 2020-21","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","64380080907","IBUPROFEN","TAB 400MG","","Select","Select",""],["","65862001705","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","85461001","DULERA ","AER 200-5MCG","13","Select","Select",""],["","781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","64380080907","IBUPROFEN ","400MG","20","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0.5","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","53489012002","DOXYCYCL","100MG","14","Select","Select",""],["","33332032001","AFLURIA","2020-21","0.5","Select","Select",""],["","53489012002","DOXYCYCL ","TAB 100MG","14","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","",""],["No","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":""}]}]}