{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LARRY E JOHNSON","gend":0,"add":"2620 WAYSIDE DRIVE","city":"NORTH CHESTERFIELD","state":"VA","zip":"23235-9998","dob":"1952-09-17","age":"","mstatus":"","insh":11005959,"cliId":"3U07XH6HR42","pno":8043897589,"cno":8043897589,"email":"","ename":"","eno":"","pphy":"CHARLTON, LEI S","ppno":8046491277,"pcpadd":"5000 MONUMENT AVENUE,STE 103","pcpcity":"RICHMOND ","pcpstate":"VA","pcpzip":232303627,"pcpcounty":"HENRICO","pcpid":"P0060251","pcpname":"LEI S CHARLTON MD PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2620 WAYSIDE DRIVE","madd2":"","madd3":"","mcity":"NORTH CHESTERFIELD","mstate":"VA","mzip":"23235-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E78.5","I10","J44.9","Z51.81","Z68.29","I42.0","N40.0","I25.9","I99.9","Z86.69","Z68.24","I42.9","H91.93","R03.0","E66.3","Z79.899","R93.89","Z72.0","Z12.2","I70.90","Z87.891","D35.01","R91.1","D35.02","K76.89","J43.9","R91.8","I25.10","Z87.438","E56.9","Z23","Z12.5","J30.2","N52.9","Z71.89","Z00.00","Z79.02","Z20.822","J30.9","Z20.828","Z13.6","E11.9","I73.9","Z68.26","E78.2","I25.83","R06.00","R07.89","I08.1","L60.2","B35.1","M54.10","M79.671","M79.672","L25.9","E11.8","J43.8","R73.03","Z28.3","Z13.1"],"date":["2021-10-19","2021-10-19","2021-11-10","2021-10-19","2021-10-19","2021-07-19","2021-05-26","2021-07-19","2021-05-26","2021-02-26","2021-07-19","2021-07-13","2020-04-27","2021-02-26","2021-11-10","2019-05-13","2021-05-05","2020-11-20","2021-07-16","2020-06-01","2021-11-10","2019-06-03","2019-06-03","2019-06-03","2019-06-03","2021-02-26","2019-06-03","2021-01-13","2019-06-03","2021-05-26","2019-11-19","2021-05-05","2019-11-19","2021-02-26","2020-11-20","2021-07-19","2020-11-20","2021-01-23","2021-07-13","2021-03-03","2021-10-19","2021-05-26","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-29","2021-01-29","2021-01-29","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-07-19","2021-07-19","2021-07-16","2021-10-19","2021-10-19","2021-05-05"],"priorHcc":["","",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":[["","55111046701","METOPROL SUC","TAB 50MG ER","","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","","Select","Select",""],["","16729021816","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","597010061","SPIRIVA","SPR 2.5MCG","","Select","Select",""],["","186037020","SYMBICORT","AER 160-4.5","","Select","Select",""],["","53746051401","SPIRONOLACT","TAB 50MG","","Select","Select",""],["","65862014930","FINASTERIDE","TAB 5MG","","Select","Select",""],["","378395105","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","","Select","Select",""],["","310737020","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","185041060","BUPROPION","TAB 100MG SR","","Select","Select",""],["","173071920","FLOVENT HFA","AER 110MCG","","Select","Select",""],["","173086910","ANORO ELLIPT","AER 62.5-25","","Select","Select",""],["","49281040565","FLUZONE HD","INJ PF 19-20","","Select","Select",""],["","6483703","PNEUMOVAX 23","INJ 25\/0.5","","Select","Select",""],["","55111019605","CLOPIDOGREL ","TAB 75MG","90","Select","Select",""],["","53746051401","SPIRONOLACT ","TAB 50MG","90","Select","Select",""],["","55111046701","METOPROL ","TAB 50MG ER","90","Select","Select",""],["","186037020","SYMBICORT ","AER 160-4.5","30.6","Select","Select",""],["","597010061","SPIRIVA ","SPR 2.5MCG","12","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","65862014930","FINASTERIDE ","TAB 5MG","90","Select","Select",""],["","378395105","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","68180096301","ALBUTEROL ","AER HFA","42.5","Select","Select",""],["","310737020","BUDES\/FORMOT ","AER 160-4.5","30.6","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","49281012065","FLUZONE ","INJ PF 20-21","0.7","Select","Select",""],["","185041060","BUPROPION ","TAB 100MG SR","30","Select","Select",""],["","173086910","ANORO ","AER 62.5-25","60","Select","Select",""],["","173071920","FLOVENT ","110MCG","12","Select","Select",""],["","6483703","PNEUMOVAX ","25\/0.5","0.5","Select","Select",""],["","55111046701","METOPROL","50MG ER","90","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","68382091634","METHYLPRED","4MG","21","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","0.7","Select","Select",""],["","45802006436","TRIAMCINOLON","0.001","80","Select","Select",""],["","00006483703","PNEUMOVAX","25\/0.5","0.5","Select","Select",""],["","00173071920","FLOVENT","110MCG","12","Select","Select",""],["","00173086910","ANORO","62.5-25","60","Select","Select",""],["","68382091634","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","60505009500","DOXAZOSIN ","TAB 4MG","90","Select","Select",""],["","45802006436","TRIAMCINOLON ","CRE 0.001","80","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":""}]}]}