{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ARTHUR J MEEKINS","gend":0,"add":"120 DEHAVEN COURT ","city":"WILLIAMSBURG","state":"VA","zip":"23188-9998","dob":"1943-09-18","age":"","mstatus":"","insh":11011763,"cliId":"7Q75RQ5RY74","pno":7576454043,"cno":7572060222,"email":"","ename":"","eno":"","pphy":"BURTON, JAMEY  ","ppno":7572208300,"pcpadd":"856 J Clyde Morris Blvd,Ste A","pcpcity":"Newport News","pcpstate":"VA","pcpzip":236011318,"pcpcounty":"","pcpid":"P9443245","pcpname":"RIVERSIDE PHYSICIAN SERVICES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"120 Dehaven Ct Apt I ","madd2":"","madd3":"","mcity":"Williamsburg","mstate":"VA","mzip":"23188-2806","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["H57.11","H16.291","H26.131","H18.20","E11.69","Z79.4","I10","E78.5","F17.210","I21.3","R58","R94.31","E11.9","K21.9","Z79.1","Z79.899","Z88.6","Z88.0","Z01.818","H57.13","R06.89","E11.59","E11.3212","Z79.84","H18.11","M19.031","M25.531","K94.31","Z87.39","M06.9","M89.8X8","H10.13","R10.32","J31.0","K59.01","Z23","N50.89","Z00.00","H35.362","M79.675","G89.29","M85.88","M85.89","Z13.820","E11.51","E11.42","Z83.3","L84","B35.1","R21","M79.672","M79.671","L85.3","L29.9","R10.13","Z71.89","Z92.29","R60.0","R06.02","D64.9","R07.9","M79.604","M79.605","L81.8","I31.3","M05.79","I50.30","I08.8","L81.0","Z71.9","L30.9","M47.816","R59.0","J41.0","I51.7","D47.2","H40.012","H18.231","E10.39","M25.471","M25.472"],"date":["2020-06-03","2020-05-19","2021-10-01","2020-03-05","2020-03-09","2021-11-22","2021-06-17","2020-10-21","2021-11-15","2020-04-13","2020-04-13","2020-06-22","2021-11-12","2020-04-13","2020-04-13","2021-07-15","2021-06-17","2021-06-17","2020-06-22","2020-04-13","2020-06-22","2021-11-22","2021-10-01","2021-11-12","2020-06-03","2020-06-22","2021-07-15","2020-06-22","2020-06-22","2020-06-22","2020-06-22","2020-08-07","2020-09-16","2020-09-14","2020-09-22","2021-10-27","2020-09-22","2020-10-21","2021-07-01","2021-01-12","2021-01-12","2021-01-14","2021-09-24","2021-01-14","2021-11-15","2021-02-03","2021-08-31","2021-02-03","2021-11-15","2021-06-17","2021-03-25","2021-03-25","2021-07-09","2021-06-17","2021-10-27","2021-11-15","2021-05-25","2021-11-15","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-07-14","2021-09-24","2021-07-14","2021-07-14","2021-08-05","2021-08-05","2021-07-09","2021-09-24","2021-06-30","2021-06-30","2021-07-14","2021-09-24","2021-10-01","2021-10-01","2021-11-15","2021-11-12","2021-11-12"],"priorHcc":["","","","","",null,"","",null,"","","",null,"","","","","","","","",null,"",null,"","","","","","","","","","","",null,"","","","","","","","",null,"","","",null,"","","","","",null,null,"",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":[["","378019901","CLONIDINE","TAB 0.3MG","","Select","Select",""],["","61314064705","TOBRA\/DEXAME","SUS 0.3-0.1%","","Select","Select",""],["","93727356","PIOGLITAZONE","TAB 45MG","","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","","Select","Select",""],["","378022201","CHLORTHALID","TAB 25MG","","Select","Select",""],["","68180048509","PRAVASTATIN","TAB 10MG","","Select","Select",""],["","574402435","ERYTHROMYCIN","OIN 5MG\/GM","","Select","Select",""],["","169643810","LEVEMIR","INJ FLEXTOUC","","Select","Select",""],["","8222095831","PEN NEEDLES","MIS 31GX8MM","","Select","Select",""],["","60758088005","FLUOROMETHOL","SUS 0.1% OP","","Select","Select",""],["","67877019910","AMLODIPINE","TAB 10MG","","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","781571010","POT CL MICRO","TAB 10MEQ ER","","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","6008061","JANUMET XR","TAB 50-1000","","Select","Select",""],["","24208078055","NEO\/BAC\/POLY","OIN OP","","Select","Select",""],["","68001036703","POT CHLORIDE","TAB 10MEQ ER","","Select","Select",""],["","574402235","BACITRACIN","OIN OP","","Select","Select",""],["","60505083305","AZELASTINE","SPR 0.001","","Select","Select",""],["","68382009401","CARVEDILOL","TAB 12.5MG","","Select","Select",""],["","603533732","PREDNISONE","TAB 5MG","","Select","Select",""],["","49884072703","DOXYCYC MONO","CAP 100MG","","Select","Select",""],["","51672125902","CLOBETASOL","OIN 0.0005","","Select","Select",""],["","60505083305","AZELASTINE ","SPR 0.001","30","Select","Select",""],["","67877019910","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","68001023900","CLONIDINE ","TAB 0.3MG","180","Select","Select",""],["","93727356","PIOGLITAZONE ","TAB 45MG","30","Select","Select",""],["","68180048509","PRAVASTATIN ","TAB 10MG","90","Select","Select",""],["","61314064705","TOBRA\/DEXAME ","SUS 0.3-0.1%","5","Select","Select",""],["","68001036703","POT  CHLORIDE","TAB 10MEQ ER","90","Select","Select",""],["","169643810","LEVEMIR ","INJ FLEXTOUC","15","Select","Select",""],["","378022201","CHLORTHALID ","TAB 25MG","30","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","8222095831","PEN  NEEDLES  ","MIS 31GX8MM","100","Select","Select",""],["","60758088005","FLUOROMETHOL ","SUS 0.1% OP","5","Select","Select",""],["","68462039610","OMEPRAZOLE ","CAP 20MG","180","Select","Select",""],["","6008061","JANUMET ","TAB 50-1000","60","Select","Select",""],["","574402435","ERYTHROMYCIN ","OIN 5MG\/GM","7","Select","Select",""],["","68382009401","CARVEDILOL ","TAB 12.5MG","180","Select","Select",""],["","713066937","HC ","OIN 0.002","45","Select","Select",""],["","781571010","POT  CL MICRO","TAB 10MEQ ER","90","Select","Select",""],["","51672125902","CLOBETASOL ","OIN 0.0005","30","Select","Select",""],["","24208078055","NEO\/BAC\/POLY ","OIN OP","3.5","Select","Select",""],["","574402235","BACITRACIN ","OIN OP","3.5","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","603533732","PREDNISONE ","TAB 5MG","30","Select","Select",""],["","49884072703","DOXYCYC ","CAP 100MG","20","Select","Select",""],["","00093506110","HYDROXYZ ","25MG","20","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00093317431","ALBUTEROL ","E","8.5","Select","Select",""],["","68001000501","METHYLPRED ","4MG","21","Select","Select",""],["","45802005536","TRIAMCINOLON ","0.001","80","Select","Select",""],["","00006008061","JANUMET","50-1000","60","Select","Select",""],["","00713066937","HC","0.002","45","Select","Select",""],["","45802005536","TRIAMCINOLON","0.001","80","Select","Select",""],["","23155050001","HYDROXYZ","10MG","30","Select","Select",""],["","49884072703","DOXYCYC","100MG","20","Select","Select",""],["","68001000501","METHYLPRED","4MG","21","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","00591256201","COLCHICINE","0.6MG","30","Select","Select",""],["","24208079535","NEO\/POLY\/DEX","0.1% OP","3.5","Select","Select",""],["","56151147004","TRUE ","KIT METER","1","Select","Select",""],["","24208079535","NEO\/POLY\/DEX ","OIN 0.1% OP","3.5","Select","Select",""],["","69315011610","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","00591256201","COLCHICINE ","TAB 0.6MG","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":""}]}]}