{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PHYLISS RICHARDS","gend":1,"add":"PHYLISS KARAMARKOVICH  POA ","city":"CHESTERFIELD","state":"VA","zip":"23838-3523","dob":"1937-11-08","age":"","mstatus":"","insh":11005851,"cliId":"6X56Q20VE86","pno":9196246160,"cno":9196246160,"email":"","ename":"","eno":"","pphy":"VCU CENTER FOR ADVANCED HEALTH","ppno":8042543500,"pcpadd":"MCV Physicians,2116 W Laburnum Ave Ste 100","pcpcity":"Richmond ","pcpstate":"VA","pcpzip":232274359,"pcpcounty":"","pcpid":"P0060414","pcpname":"VCU CENTER FOR ADVANCED HEALTH","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"12013EAGLE PASS DRIVE","add3":"","madd1":"PHYLISS KARAMARKOVICH  POA ","madd2":"12013EAGLE PASS DRIVE","madd3":"","mcity":"CHESTERFIELD","mstate":"VA","mzip":"23838-3523","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["N39.0","J20.9","J45.30","J30.9","F03.90","R39.81","N39.3","N32.81","R41.82","J45.21","Z91.19","J44.9","G40.89","R30.0","R05","G47.00","Z79.899","J45.20","Z04.3","G40.909","R56.9","G30.1","F31.9","L30.9","T78.40XA","R21","R60.0","L84","R29.6","E03.9","R26.2","B35.1","I73.9","M79.676","M19.90","J96.00","R26.81","Z91.81","M15.0","S80.822A","K08.89","R06.2","G31.09","L57.0","G25.9","C44.612","D04.71","L82.0","L98.499","D48.9","L82.1","L56.8","Z12.83","M62.81","R26.9","I70.0","J45.901","F05","N30.00","H61.23","M25.551","Z96.641","W19.XXXA","M19.071","H61.22","J30.89","H65.02","J44.1","Z96.649","M79.89","R06.02","Z79.51","R09.02","Z01.89","B37.2","I50.1","I34.0","S60.211A","R40.4","G30.9","I87.2","H92.02","H93.13","H69.81","F44.5","M54.5","M85.80","M85.88","M51.36","Z82.49","R41.0","I44.0","Z20.822","R91.8","Z68.22","Z66","Z03.818","D04.72","G40.409","R52","R26.89","M70.61","Z87.81","Z51.81","M25.559","B96.1","M81.0","Z13.820","R10.84","H60.8X3","R19.7","N20.0","K80.20","Z87.891","Q21.1","Z87.440","Z99.89","J96.11","S32.020A","R63.0","R63.4","R06.00","Z99.81","Z88.4","Z88.0","Z88.2","Z88.1","Z88.5","Z88.8"],"date":["2021-11-23","2019-12-11","2020-09-17","2021-07-30","2021-09-16","2021-11-29","2021-11-29","2021-11-29","2021-04-04","2021-07-05","2019-02-21","2021-08-29","2021-11-16","2020-10-26","2020-02-24","2019-02-27","2021-11-23","2021-11-16","2019-03-07","2021-11-23","2021-08-29","2021-10-26","2021-04-13","2019-04-24","2019-05-02","2020-06-16","2021-08-12","2019-05-17","2021-10-18","2021-11-16","2021-09-16","2021-08-12","2021-08-12","2021-08-12","2021-04-01","2020-07-01","2021-09-16","2020-07-01","2021-03-25","2020-06-11","2020-06-16","2019-06-20","2021-11-23","2021-04-19","2020-08-13","2019-09-10","2021-04-19","2021-04-19","2019-08-19","2021-04-19","2021-04-19","2019-08-19","2019-08-19","2021-09-16","2019-11-01","2019-12-02","2019-09-09","2019-10-27","2021-05-03","2020-09-28","2021-05-05","2021-05-05","2021-07-31","2019-10-13","2020-11-16","2021-09-02","2020-10-19","2021-06-30","2021-07-28","2019-10-26","2019-12-02","2021-04-13","2019-10-25","2019-10-25","2020-11-05","2019-12-06","2019-12-06","2019-12-23","2021-02-09","2021-06-30","2020-08-13","2020-10-17","2020-10-17","2020-10-17","2021-05-03","2021-07-31","2021-05-05","2021-03-08","2021-07-31","2021-04-04","2021-04-05","2021-04-13","2021-04-13","2021-04-04","2021-04-05","2021-07-28","2021-04-13","2021-04-19","2021-04-20","2021-04-27","2021-05-03","2021-05-05","2021-05-05","2021-11-23","2021-06-02","2021-04-13","2021-06-03","2021-06-03","2021-07-05","2021-07-05","2021-08-31","2021-11-23","2021-07-28","2021-08-25","2021-07-28","2021-07-28","2021-11-29","2021-10-26","2021-07-31","2021-10-05","2021-10-26","2021-10-25","2021-10-25","2021-08-29","2021-08-29","2021-08-29","2021-08-29","2021-08-29","2021-08-29"],"priorHcc":[null,"","","","",null,null,null,"","","",null,null,"","","",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":[["","781598801","CARBAMAZEPIN","TAB 400MG ER","","Select","Select",""],["","59746024501","LAMOTRIGINE","TAB 25MG","","Select","Select",""],["","487020101","IPRATROPIUM\/","SOL ALBUTER","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","591544310","PREDNISONE","TAB 20MG","","Select","Select",""],["","173088714","TRELEGY","AER ELLIPTA","","Select","Select",""],["","57237005860","CEFUROXIME","TAB 250MG","","Select","Select",""],["","378210005","LOPERAMIDE","CAP 2MG","","Select","Select",""],["","713022580","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","76204020030","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","69238183407","LEVOTHYROXIN","TAB 100MCG","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","","Select","Select",""],["","68462034690","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","68180016006","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","781751687","BUDESONIDE","SUS 0.5MG\/2","","Select","Select",""],["","70700026894","FOSFOMYCIN","POW 3GM","","Select","Select",""],["","143980305","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","45802036862","IMIQUIMOD","CRE 0.05","","Select","Select",""],["","63304069201","CLINDAMYCIN","CAP 150MG","","Select","Select",""],["","64980018106","DIFLUNISAL","TAB 500MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","","Select","Select",""],["","574200815","NYSTOP","POW 100000","","Select","Select",""],["","69238152201","TETRACYCLINE","CAP 250MG","","Select","Select",""],["","93101042","MUPIROCIN","OIN 0.02","","Select","Select",""],["","131247735","VIMPAT","TAB 50MG","","Select","Select",""],["","65628020810","FIRVANQ","SOL 50MG\/ML","","Select","Select",""],["","57237005860","CEFUROXIME ","TAB 250MG","30","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","68462034690","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","29300022019","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","51672412501","CARBAMAZEPIN ","TAB 400MG ER","60","Select","Select",""],["","67877025115","TRIAMCINOLON ","CRE 0.001","15","Select","Select",""],["","59746024501","LAMOTRIGINE ","TAB 25MG","120","Select","Select",""],["","69238183407","LEVOTHYROXIN ","TAB 100MCG","14","Select","Select",""],["","76204020030","ALBUTEROL ","NEB 0.00083","90","Select","Select",""],["","378210005","LOPERAMIDE ","CAP 2MG","90","Select","Select",""],["","487020101","IPRATROPIUM\/ ","SOL ALBUTER","90","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","173088714","TRELEGY ","AER ELLIPTA","28","Select","Select",""],["","591544310","PREDNISONE ","TAB 20MG","3","Select","Select",""],["","68180016006","AZITHROMYCIN ","TAB 250MG","4","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","781751687","BUDESONIDE ","SUS 0.5MG\/2","60","Select","Select",""],["","69238152201","TETRACYCLINE ","CAP 250MG","40","Select","Select",""],["","70700026894","FOSFOMYCIN ","POW 3GM","1","Select","Select",""],["","93101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","10","Select","Select",""],["","574200815","NYSTOP ","POW 100000","15","Select","Select",""],["","131247735","VIMPAT ","TAB 50MG","60","Select","Select",""],["","143980305","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","45802036862","IMIQUIMOD ","CRE 0.05","24","Select","Select",""],["","64980018106","DIFLUNISAL ","TAB 500MG","14","Select","Select",""],["","63304069201","CLINDAMYCIN ","CAP 150MG","30","Select","Select",""],["","65628020810","FIRVANQ ","SOL 50MG\/ML","300","Select","Select",""],["","781320895","CEFTRIAXONE ","1GM","1","Select","Select",""],["","59310057922","PROAIR ","","8.5","Select","Select",""],["","60505036301","OFLOXACIN ","0.3%OTIC","5","Select","Select",""],["","60505036301","OFLOXACIN","0.3%OTIC","5","Select","Select",""],["","69097052444","DICLOFENAC","0.01","100","Select","Select",""],["","00781320895","CEFTRIAXONE","1GM","1","Select","Select",""],["","00143980305","DOXYCYCL","100MG","14","Select","Select",""],["","59310057922","PROAIR","","8.5","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","",""],["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":""}]}]}