{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARION G GOODE","gend":1,"add":"3118 LAMB AVE  ","city":"RICHMOND ","state":"VA","zip":"23222-9998","dob":"1949-10-23","age":"","mstatus":"","insh":11004297,"cliId":"7F77XJ0DQ40","pno":8043343760,"cno":8046258976,"email":"","ename":"","eno":"","pphy":"LATHAM, RUTH","ppno":8047641253,"pcpadd":"8220 Meadowbridge Rd,Ste 203","pcpcity":"Mechanicsville ","pcpstate":"VA","pcpzip":231162339,"pcpcounty":"","pcpid":"P9058406","pcpname":"BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"3008 Hanes Ave Apt 2 ","madd2":"","madd3":"","mcity":"Richmond ","mstate":"VA","mzip":"23222-2621","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["H61.23","Z86.69","H90.A22","H69.80","H90.5","H91.20","H90.3","G47.33","H66.90","E78.2","I10","E11.22","K21.9","M79.2","M54.5","N18.3","Z68.34","H91.90","M54.31","G56.03","M54.32","Z68.41","E78.00","G44.219","I16.0","R51","J45.909","M19.90","E66.01","I12.9","Z79.4","Z79.899","R07.9","M47.817","M48.062","M43.10","E11.42","R20.0","E55.9","D63.1","D50.9","M25.569","E11.9","E61.1","B35.1","E11.49","M79.671","I50.9","I51.9","Z12.31","M25.571","M25.572","Z74.09","R60.0","R35.0","Z00.00","M79.602","Z78.0","Z13.6","M89.9","M94.9","Z13.820","Z68.39","M79.672","R06.09","R20.2","N18.30","N39.0","E78.5","E87.6","G47.30","H91.13","K59.00","L90.5","M13.0","M47.819","N39.41","Z79.51","Z82.49","Z96.22","Z96.653","Z97.4","Z99.89","Z20.828","R11.0","J45.31","Z68.35","I50.32","M79.673","E11.40","L85.1","S00.83XA","R51.9","W01.0XXA","I25.10","Z96.652","S09.90XA","W01.111A","Y92.019","Y93.01","G44.209","H40.9","Z87.11","Z79.1","M79.89","R42","R55","E11.36","H26.9","M19.041","M19.042","M25.561","M25.562","M54.2","N18.32","S06.0X0D","R20.8","G56.01","M51.36","M48.061","M47.816","M51.17","M47.27","M48.07","M54.16","N18.9","S06.0X0A","G44.329","G44.221","Z68.33","E08.42","Z68.36","M51.37","M54.50","Z68.37"],"date":["2021-03-08","2020-09-23","2020-09-23","2019-01-31","2019-02-11","2019-03-14","2021-03-08","2021-07-20","2019-01-31","2020-02-12","2021-11-16","2021-10-08","2021-05-10","2020-02-12","2021-07-01","2020-09-28","2021-01-07","2019-03-01","2021-11-04","2020-11-03","2021-08-04","2019-07-29","2021-11-16","2019-03-24","2019-03-24","2020-08-21","2021-03-25","2021-03-25","2021-04-15","2021-03-29","2021-11-16","2021-02-25","2019-03-24","2019-06-05","2021-11-18","2021-11-18","2021-11-04","2020-05-13","2021-05-10","2021-11-11","2021-04-15","2021-04-15","2021-11-16","2021-04-15","2021-09-22","2019-10-02","2019-10-02","2020-06-05","2020-07-06","2021-09-13","2018-09-05","2018-09-05","2018-09-05","2018-11-10","2018-08-29","2018-08-29","2018-08-29","2018-09-11","2018-08-29","2018-09-11","2018-09-11","2018-09-11","2019-09-12","2019-10-02","2018-11-08","2020-10-30","2021-11-11","2021-04-15","2021-02-25","2018-12-05","2018-11-10","2018-11-10","2018-11-10","2018-11-10","2018-11-10","2018-11-10","2018-11-10","2021-03-25","2018-11-10","2018-11-10","2021-05-20","2018-11-10","2018-11-10","2020-11-19","2018-12-05","2018-12-05","2019-12-19","2021-01-07","2021-09-22","2021-09-22","2021-09-22","2021-02-15","2021-02-25","2021-02-15","2021-03-25","2021-02-15","2021-02-15","2021-02-15","2021-02-15","2021-02-15","2021-02-25","2021-03-25","2021-03-25","2021-02-25","2021-02-15","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-06-29","2021-06-29","2021-05-20","2021-05-20","2021-05-20","2021-10-08","2021-03-31","2021-06-03","2021-07-20","2021-11-04","2021-11-18","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-20","2021-08-20","2021-04-16","2021-10-25","2021-04-16","2021-04-16","2021-10-25","2021-10-25","2021-10-25","2021-11-18","2021-11-16"],"priorHcc":["","","","","","","","","","",null,"","","","","","","",null,"","","",null,"","","","","","","",null,"","","",null,null,null,"","",null,"","",null,"","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,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":[["","65862029590","ROSUVASTATIN","TAB 20MG","","Select","Select",""],["","58657060401","LABETALOL","TAB 300MG","","Select","Select",""],["","169369619","NOVOLOG MIX","INJ FLEXPEN","","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","73070020315","INS ASP PROT","INJ FLEXPEN","","Select","Select",""],["","31722052201","HYDRALAZINE","TAB 100MG","","Select","Select",""],["","64380086107","POT CHLORIDE","TAB 10MEQ ER","","Select","Select",""],["","54429731","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","","Select","Select",""],["","65702049310","ACCU-CHEK","TES SMART","","Select","Select",""],["","8290320109","BD PEN NEEDL","MIS 31GX8MM","","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","","Select","Select",""],["","49281040565","FLUZONE HD","INJ PF 19-20","","Select","Select",""],["","65862001905","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","70461012003","FLUAD QUADRI","INJ 0.5ML","","Select","Select",""],["","55111012601","CIPROFLOXACN","TAB 250MG","","Select","Select",""],["","60505025103","TIZANIDINE","TAB 2MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","31722052201","HYDRALAZINE ","TAB 100MG","270","Select","Select",""],["","58657060450","LABETALOL ","TAB 300MG","270","Select","Select",""],["","54429731","FUROSEMIDE ","TAB 20MG","180","Select","Select",""],["","169369619","NOVOLOG ","INJ FLEXPEN","15","Select","Select",""],["","378456105","POT  CHLORIDE","TAB 10MEQ ER","90","Select","Select",""],["","68462039710","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","73070020315","INS ","INJ FLEXPEN","15","Select","Select",""],["","55111012601","CIPROFLOXACN ","TAB 250MG","14","Select","Select",""],["","65862029590","ROSUVASTATIN ","TAB 20MG","90","Select","Select",""],["","65702049210","ACCU-CHEK ","TES SMART","200","Select","Select",""],["","8290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","60505025103","TIZANIDINE ","TAB 2MG","30","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","70461012003","FLUAD ","0.5ML","0.5","Select","Select",""],["","65862001905","CEPHALEXIN ","500MG","14","Select","Select",""],["","49281040565","FLUZONE ","PF 19-20","0.5","Select","Select",""],["","00169369619","NOVOLOG","FLEXPEN","15","Select","Select",""],["","73070020315","INS","FLEXPEN","15","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","65162062711","TRAMADOL","50MG","15","Select","Select",""],["","70461012003","FLUAD","0.5ML","0.5","Select","Select",""],["","49281040565","FLUZONE","PF 19-20","0.5","Select","Select",""],["","69097081312","GABAPENTIN ","CAP 100MG","120","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","15","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":""}]}]}