{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELDA M GAMMON","gend":1,"add":"1418 OVERLOOK STREET ","city":"RICHMOND ","state":"VA","zip":"23224-9998","dob":"1965-08-26","age":"","mstatus":"","insh":11007502,"cliId":"7VN4J10QN99","pno":8043862939,"cno":8042188680,"email":"","ename":"","eno":"","pphy":"ARMISTEAD, SCOTT  ","ppno":8043201333,"pcpadd":"4730 N Southside Plaza St","pcpcity":"Richmond ","pcpstate":"VA","pcpzip":232241742,"pcpcounty":"","pcpid":"P0060162","pcpname":"VCUHS HAYES E WILLIS HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1418 OVERLOOK STREET ","madd2":"","madd3":"","mcity":"RICHMOND ","mstate":"VA","mzip":"23224-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["J01.90","H25.13","H25.21","H25.12","H25.89","Z01.818","H25.11","K62.3","Z01.812","Z20.822","D12.2","Z86.010","Z12.11","K63.5","F17.210","Z89.022","Z79.899","Z72.0","Z00.00","Z13.31","M54.12","G89.29","Z96.89","K64.1","K64.4","G89.4","Z45.1","K75.9","R74.02","M54.50","R51.9","M19.90","Z79.891","Z87.891","Z48.811","T85.695A"],"date":["2021-05-13","2020-10-28","2020-11-18","2021-02-05","2020-11-02","2021-01-26","2021-01-28","2021-03-23","2021-10-04","2021-10-13","2021-03-19","2021-08-24","2021-03-19","2021-03-19","2021-03-23","2021-03-19","2021-03-23","2021-05-13","2021-06-22","2021-06-22","2021-08-18","2021-10-15","2021-08-18","2021-08-24","2021-08-24","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-11-01","2021-10-15"],"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":[["","60758011905","PREDNISOLONE","SUS 1% OP","","Select","Select",""],["","52268001201","SUPREP BOWEL","SOL PREP KIT","","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","","Select","Select",""],["","16714039102","CEFDINIR","CAP 300MG","","Select","Select",""],["","65862084003","MOXIFLOXACIN","SOL HCL 0.5%","","Select","Select",""],["","49708075441","BROMSITE","DRO 0.00075","","Select","Select",""],["","603533815","PREDNISONE","PAK 10MG","","Select","Select",""],["","60758011905","PREDNISOLONE ","SUS 1% OP","5","Select","Select",""],["","65862084003","MOXIFLOXACIN ","SOL HCL 0.5%","3","Select","Select",""],["","49708075441","BROMSITE ","DRO 0.00075","5","Select","Select",""],["","52268001201","SUPREP ","SOL PREP KIT","354","Select","Select",""],["","72647033104","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","65862019105","CYCLOBENZAPR ","TAB 10MG","10","Select","Select",""],["","57237002801","AMOXICILLIN ","TAB 500MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","65162004710","OXYCODONE ","5MG","10","Select","Select",""],["","603533815","PREDNISONE ","10MG","21","Select","Select",""],["","16714039102","CEFDINIR ","300MG","20","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","65862019105","CYCLOBENZAPR","10MG","10","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","30","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","70010077001","METHOCARBAM","750MG","42","Select","Select",""],["","70010077001","METHOCARBAM ","TAB 750MG","42","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":""}]}]}