{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELIZABETH A MERRITT","gend":1,"add":"2202 FOX BURROW DRIVE","city":"HENRICO  ","state":"VA","zip":"23238-9998","dob":"1976-06-09","age":"","mstatus":"","insh":11006066,"cliId":"3DM8DN1QP38","pno":2079390334,"cno":2077491115,"email":"","ename":"","eno":"","pphy":"SHERRARD, LINDSAY ","ppno":8047416200,"pcpadd":"9600 PATTERSON AVE","pcpcity":"HENRICO  ","pcpstate":"VA","pcpzip":232296053,"pcpcounty":"HENRICO","pcpid":"P0060015","pcpname":"PATTERSON AVENUE FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2202 FOX BURROW DRIVE","madd2":"","madd3":"","mcity":"HENRICO  ","mstate":"VA","mzip":"23238-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["B30.9","H57.12","I10","F17.200","Z88.0","M25.561","G89.29","Z68.27","E66.3","Z72.0","G43.019","K21.9","R05","T46.4X5A","R63.5","R11.0","Z68.28","Z01.419","Z12.31","N63.20","Z11.59","Z11.4","K08.89","R68.84","N60.12","H26.053","H52.13","H52.223","M18.11","G43.009","N93.8","E03.9","N92.6","F84.5","Z12.4","Z86.39","N60.02","R92.8","M72.2","Z00.00","M79.641","J30.2","Z68.29","G43.829","Z87.891","E73.9","E66.9","Z68.31","Z79.899"],"date":["2021-08-30","2019-01-03","2021-10-12","2019-10-04","2019-01-03","2019-02-14","2019-02-14","2019-02-14","2021-02-16","2019-02-14","2019-02-14","2021-04-16","2019-02-14","2019-02-14","2020-10-12","2020-07-27","2020-07-27","2020-08-13","2021-10-13","2020-09-24","2019-10-03","2019-10-03","2019-10-04","2019-10-04","2021-04-14","2019-12-26","2019-12-26","2019-12-26","2021-01-25","2021-10-12","2020-04-02","2020-06-12","2021-04-16","2021-10-12","2020-07-13","2020-07-13","2020-10-14","2021-04-14","2020-09-01","2021-10-12","2020-10-12","2021-10-12","2021-04-16","2021-10-18","2021-06-15","2021-10-12","2021-10-12","2021-10-12","2021-10-18"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","65862020190","LOSARTAN POT","TAB 25MG","","Select","Select",""],["","68382092386","ELETRIPTAN","TAB 40MG","","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","","Select","Select",""],["","93081301","NORTRIPTYLIN","CAP 75MG","","Select","Select",""],["","93770198","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","55513084101","AIMOVIG","INJ 70MG\/ML","","Select","Select",""],["","70710122901","AMITRIPTYLIN","TAB 100MG","","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","51991081701","PROPRANOLOL","CAP 60MG ER","","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","","Select","Select",""],["","70461031903","FLUCLVX QUAD","INJ 2019-20","","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","","Select","Select",""],["","75987004005","PENNSAID","SOL 0.02","","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","","Select","Select",""],["","93220305","METOCLOPRAM","TAB 10MG","","Select","Select",""],["","65862020190","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","93081301","NORTRIPTYLIN ","CAP 75MG","60","Select","Select",""],["","55513084101","AIMOVIG ","INJ 70MG\/ML","1","Select","Select",""],["","93770198","LEVOCETIRIZI ","TAB 5MG","90","Select","Select",""],["","68382092386","ELETRIPTAN ","TAB 40MG","9","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","90","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","70710122901","AMITRIPTYLIN ","TAB 100MG","30","Select","Select",""],["","75987004005","PENNSAID ","SOL 0.02","112","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","51991081701","PROPRANOLOL ","CAP 60MG ER","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","68180051303","LISINOPRIL ","TAB 5MG","90","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","60","Select","Select",""],["","93220305","METOCLOPRAM ","TAB 10MG","30","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","48","Select","Select",""],["","63304069205","CLINDAMYCIN ","CAP 150MG","63","Select","Select",""],["","70461031903","FLUCLVX ","INJ 2019-20","0.5","Select","Select",""],["","58160084252","BOOSTRIX ","","0.5","Select","Select",""],["","65862020190","LOSARTAN","25MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","48","Select","Select",""],["","70461031903","FLUCLVX","2019-20","0.5","Select","Select",""],["","59746011506","PROCHLORPER ","TAB 10MG","20","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":""}]}]}