{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICHARD W STOKES","gend":0,"add":"206HOSPITAL STREET","city":"Richmond ","state":"VA","zip":"23219-1119","dob":"1945-08-12","pno":8047736553,"cno":8047736553,"email":"","pphy":"JACKSON, RICHARD A","ppno":8042257148,"pcpadd":"304 E Leigh St","pcpcity":"Richmond ","pcpstate":"VA","pcpzip":232191410,"pcpcounty":"","pcpid":"P0124311","pcpname":"DOMINION MEDICAL ASSOCIATES INC","insh":11009566,"cliId":"7N34KX8TA82","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT 308  ","add3":"","madd1":"206HOSPITAL STREET","madd2":"APT 308  ","madd3":"","mcity":"Richmond ","mstate":"VA","mzip":"23219-1119","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E83.42","K59.00","N17.9","K43.9","I10","Z91.14","R33.9","N40.1","K59.8","K44.9","N40.0","Z68.23","Z87.891","I11.9","R06.02","R94.31","R79.89","E55.9","E53.8","R53.1","R63.4","H93.299","R79.9","Z92.29","C61","H90.5","E87.6","Z12.5","Z79.899","K13.79","K08.89","Z13.9","Z11.59","S22.49XA","R97.20","N39.0","I12.9","E05.90","N18.4","F17.200","R89.9","R69"],"date":["2020-05-02","2020-03-10","2020-03-10","2020-03-23","2021-10-26","2020-03-10","2020-05-26","2020-05-26","2020-03-10","2020-03-10","2020-03-10","2020-06-23","2020-03-23","2020-06-23","2020-06-23","2020-03-23","2020-06-23","2020-06-23","2020-06-23","2020-03-23","2020-03-23","2020-03-23","2020-06-23","2021-10-22","2021-10-28","2020-04-16","2020-05-02","2020-05-26","2020-05-26","2020-05-27","2020-06-08","2020-05-27","2020-06-08","2020-06-23","2021-10-28","2020-06-23","2021-10-22","2021-10-22","2021-10-22","2021-10-22","2021-10-22","2021-10-01"],"priorHcc":["","","","",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":[]},{"a":[]}]},{"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":[["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","30.6","Select","Select",""],["","65862078130","OLM","40-25MG","90","Select","Select",""],["","00173086910","ANORO","62.5-25","180","Select","Select",""],["","16714071302","TAMSULOSIN","0.4MG","30","Select","Select",""],["","65862014905","FINASTERIDE","5MG","30","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","8","Select","Select",""],["","67877032005","IBUPROFEN","600MG","20","Select","Select",""],["","00093310953","AMOXICILLIN","500MG","21","Select","Select",""],["","00781165501","PENICILLN","500MG","40","Select","Select",""],["","00597015561","STIOLTO","2.5-2.5","4","Select","Select",""],["","16714071302","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","65862014905","FINASTERIDE ","TAB 5MG","30","Select","Select",""],["","00597015561","STIOLTO ","AER 2.5-2.5","4","Select","Select",""],["","00173086910","ANORO ","AER 62.5-25","180","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","20","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","8","Select","Select",""],["","65862078130","OLM ","TAB 40-25MG","90","Select","Select",""],["","00093310953","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","00310737020","BUDES\/FORMOT ","AER 160-4.5","30.6","Select","Select",""],["","00781183120","AMOX\/K ","TAB 500-125","20","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","00781165501","PENICILLN ","TAB 500MG","40","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","",""],["Yes","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":""}]}]}