{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GLENN M THORNE","gend":0,"add":"315 KOCH AVE","city":"RICHMOND ","state":"VA","zip":"23223-9998","dob":"1957-07-08","age":"","mstatus":"","insh":11006729,"cliId":"2EY7WT6YN77","pno":8042372586,"cno":8042372586,"email":"","ename":"","eno":"","pphy":"AVULA, JONATHAN S ","ppno":8042262444,"pcpadd":"4620 S Laburnum Ave","pcpcity":"Richmond ","pcpstate":"VA","pcpzip":232312424,"pcpcounty":"","pcpid":"P0113848","pcpname":"LABURNUM MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"315 KOCH AVE","madd2":"","madd3":"","mcity":"RICHMOND ","mstate":"VA","mzip":"23223-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M54.5","M79.2","G89.29","Z79.891","M79.10","F11.20","G90.09","R53.83","Z00.00","M15.0","I25.728","I11.9","E78.2","Z72.0","Z53.21","I10","E78.5","M54.16","M48.061","M48.07","I71.4","N28.1"],"date":["2021-06-11","2021-09-21","2021-02-02","2020-02-18","2021-10-18","2021-04-15","2020-02-18","2019-10-22","2019-10-22","2021-05-20","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-08-04","2021-10-18","2019-10-14","2021-10-18","2021-06-11","2021-06-11","2021-06-11","2021-06-11"],"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":[["","69547035302","NARCAN","SPR ","","Select","Select",""],["","60505025103","TIZANIDINE","TAB 2MG","","Select","Select",""],["","10702005601","OXYCODONE","TAB 10MG","","Select","Select",""],["","378020810","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","59385002360","BELBUCA","MIS 300MCG","","Select","Select",""],["","69584061250","METHOCARBAM","TAB 750MG","","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","","Select","Select",""],["","69097084615","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","93720198","PRAVASTATIN","TAB 20MG","","Select","Select",""],["","57664016758","METOPROL TAR","TAB 100MG","","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","","Select","Select",""],["","378104901","DOXEPIN HCL","CAP 10MG","","Select","Select",""],["","93081201","NORTRIPTYLIN","CAP 50MG","","Select","Select",""],["","70461041910","FLUCLVX QUAD","INJ 2019-20","","Select","Select",""],["","59385002360","BELBUCA ","MIS 300MCG","60","Select","Select",""],["","60505025103","TIZANIDINE ","TAB 2MG","120","Select","Select",""],["","10702005601","OXYCODONE ","TAB 10MG","120","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","69547035302","NARCAN ","SPR ","4","Select","Select",""],["","93720198","PRAVASTATIN ","TAB 20MG","90","Select","Select",""],["","378020810","FUROSEMIDE ","TAB 20MG","90","Select","Select",""],["","69097084615","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","57664016758","METOPROL ","TAB 100MG","180","Select","Select",""],["","69584061250","METHOCARBAM ","TAB 750MG","90","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","378104901","DOXEPIN ","CAP 10MG","30","Select","Select",""],["","70461041910","FLUCLVX ","INJ 2019-20","0.5","Select","Select",""],["","93081201","NORTRIPTYLIN ","50MG","90","Select","Select",""],["","57664016758","METOPROL","100MG","180","Select","Select",""],["","00378104901","DOXEPIN","10MG","30","Select","Select",""],["","70461041910","FLUCLVX","2019-20","0.5","Select","Select",""],["","43598029590","PREGABALIN","150MG","60","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","14","Select","Select",""],["","43598029590","PREGABALIN ","CAP 150MG","60","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","",""],["Yes","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":""}]}]}