{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SANDRA MELLINS","gend":1,"add":"GRACE HOUSE ","city":"RICHMOND ","state":"VA","zip":"23220-2003","dob":"1958-01-29","age":"","mstatus":"","insh":11007263,"cliId":"2M58AG1AQ26","pno":8043531718,"cno":8043531718,"email":"","ename":"","eno":"","pphy":"SHRIDHAR V BHAT","ppno":8047802610,"pcpadd":"110 N Robinson St,Ste 305","pcpcity":"Richmond ","pcpstate":"VA","pcpzip":232204461,"pcpcounty":"","pcpid":"P0060164","pcpname":"CENTER FOR INTERNAL MEDICINE AND HYPERTENSION","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"2027  W GRACE STREET ","add3":"","madd1":"GRACE HOUSE ","madd2":"2027  W GRACE STREET ","madd3":"","mcity":"RICHMOND ","mstate":"VA","mzip":"23220-2003","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F20.0","R39.81","L60.2","L60.3","R32","D48.5","C44.91","C44.1121","L98.9","E78.1","J44.9","I10","E78.6","E78.00","F20.9","C44.311","L98.8","Z79.899","R22.9","F34.9","E78.5","Z72.0","F17.210","Z68.25","Z01.818","C76.0","Z11.59","D04.9","L21.9","L81.4","C44.310","L85.3","Z00.00","Z90.49","C44.1122","Z13.89"],"date":["2021-10-11","2020-02-24","2020-04-28","2020-04-28","2019-07-22","2020-06-25","2021-06-16","2021-07-08","2020-09-21","2021-10-21","2021-06-22","2020-12-15","2019-08-20","2020-12-15","2021-07-08","2020-12-23","2020-10-15","2021-05-17","2020-10-15","2019-11-26","2020-08-10","2019-11-26","2020-08-10","2020-08-10","2020-12-23","2021-01-06","2021-01-06","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-09-22","2021-05-13","2021-07-08","2021-10-21"],"priorHcc":[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":[["","93092606","LOVASTATIN","TAB 10MG","","Select","Select",""],["","121058104","HALOPERIDOL","CON 2MG\/ML","","Select","Select",""],["","69315013801","BENZTROPINE","TAB 2MG","","Select","Select",""],["","50458056401","INVEGA SUST","INJ 234\/1.5","","Select","Select",""],["","781598701","CARBAMAZEPIN","TAB 200MG ER","","Select","Select",""],["","50742061510","METOPROL SUC","TAB 25MG ER","","Select","Select",""],["","49281041988","FLUZONE QUAD","INJ 2019-20","","Select","Select",""],["","168009960","KETOCONAZOLE","CRE 0.02","","Select","Select",""],["","58160088552","FLUARIX QUAD","INJ 2020-21","","Select","Select",""],["","50458056401","INVEGA ","INJ 234\/1.5","1.5","Select","Select",""],["","121058104","HALOPERIDOL ","CON 2MG\/ML","240","Select","Select",""],["","69315013801","BENZTROPINE ","TAB 2MG","62","Select","Select",""],["","93092606","LOVASTATIN ","TAB 10MG","31","Select","Select",""],["","58160088552","FLUARIX ","INJ 2020-21","0.5","Select","Select",""],["","781598701","CARBAMAZEPIN ","TAB 200MG ER","62","Select","Select",""],["","50742061510","METOPROL ","TAB 25MG ER","29","Select","Select",""],["","49281041988","FLUZONE ","INJ 2019-20","0.5","Select","Select",""],["","168009960","KETOCONAZOLE ","CRE 0.02","60","Select","Select",""],["","50458056401","INVEGA","234\/1.5","1.5","Select","Select",""],["","58160088552","FLUARIX","2020-21","0.5","Select","Select",""],["","50742061510","METOPROL","25MG ER","31","Select","Select",""],["","49281041988","FLUZONE","2019-20","0.5","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","",""],["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":""}]}]}