{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTHONY E WILBY III","gend":0,"add":"1704 Broadmoor Dr ","city":"Henrico  ","state":"VA","zip":"23229-4914","dob":"1980-10-06","age":"","mstatus":"","insh":11007173,"cliId":"3XF8WE7WU67","pno":8044676666,"cno":8044676666,"email":"","ename":"","eno":"","pphy":"SHRIDHAR V BHAT","ppno":8047802610,"pcpadd":"110 N Robinson St,Ste 305","pcpcity":"Richmond ","pcpstate":"VA","pcpzip":232204461,"pcpcounty":"","pcpid":"P0124391","pcpname":"PARHAM HEALTHCARE & REHAB CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"Lyla Wilby  ","add3":"","madd1":"1704 Broadmoor Dr ","madd2":"Lyla Wilby  ","madd3":"","mcity":"Henrico  ","mstate":"VA","mzip":"23229-4914","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E88.9","I10","E78.5","E55.9","E03.9","E11.9","Z00.00","E78.1","F84.0","K62.5","K64.9","E66.9","F25.9","R56.9","E66.01","R73.03","E50.9","R73.9"],"date":["2020-05-18","2021-10-19","2020-05-18","2021-08-30","2020-05-18","2020-07-31","2020-07-31","2019-07-19","2021-10-19","2019-07-19","2019-07-19","2019-07-19","2020-07-31","2019-07-19","2020-07-31","2021-08-30","2021-08-30","2021-10-19"],"priorHcc":["",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":[["","68382011514","RISPERIDONE","TAB 2MG","","Select","Select",""],["","67405065105","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","65862001105","SERTRALINE","TAB 25MG","","Select","Select",""],["","23155010210","METFORMIN","TAB 500MG","","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","68462018022","MUPIROCIN","OIN 0.02","","Select","Select",""],["","45802000403","HYDROCORT","CRE 0.025","","Select","Select",""],["","70461031903","FLUCLVX QUAD","INJ 2019-20","","Select","Select",""],["","781261305","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","6483703","PNEUMOVAX 23","INJ 25\/0.5","","Select","Select",""],["","45802088094","NYSTAT\/TRIAM","CRE ","","Select","Select",""],["","49281042050","FLUZONE QUAD","INJ 2020-21","","Select","Select",""],["","67405065105","DOXYCYCL ","CAP 100MG","90","Select","Select",""],["","68462039610","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","43547034106","RISPERIDONE ","TAB 1MG","90","Select","Select",""],["","69097083312","SERTRALINE ","TAB 25MG","90","Select","Select",""],["","23155010210","METFORMIN ","TAB 500MG","360","Select","Select",""],["","45802000403","HYDROCORT ","CRE 0.025","28","Select","Select",""],["","58160084252","BOOSTRIX ","INJ ","0.5","Select","Select",""],["","68462018022","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","70461031903","FLUCLVX ","INJ 2019-20","0.5","Select","Select",""],["","781261305","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0.5","Select","Select",""],["","6483703","PNEUMOVAX ","25\/0.5","0.5","Select","Select",""],["","45802088094","NYSTAT\/TRIAM ","","30","Select","Select",""],["","62135098505","DOXYCYCL","100MG","90","Select","Select",""],["","70461031903","FLUCLVX","2019-20","0.5","Select","Select",""],["","49281042050","FLUZONE","2020-21","0.5","Select","Select",""],["","00006483703","PNEUMOVAX","25\/0.5","0.5","Select","Select",""],["","68001044503","POT CHLORIDE","20MEQ ER","90","Select","Select",""],["","65862046899","LOSARTAN\/HCT","50-12.5","30","Select","Select",""],["","53885024510","ONETOUCH","ULTRA","100","Select","Select",""],["","33332032101","AFLURIA","2021-22","0.5","Select","Select",""],["","68001044503","POT  CHLORIDE","TAB 20MEQ ER","90","Select","Select",""],["","67877019810","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","53885024510","ONETOUCH ","TES ULTRA","100","Select","Select",""],["","33332032101","AFLURIA ","INJ 2021-22","0.5","Select","Select",""],["","65862046899","LOSARTAN\/HCT ","TAB 50-12.5","30","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","",""],["No","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":""}]}]}