{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EUGENE A PARRISH","gend":0,"add":"5108 TIFFANY WOODS COURT","city":"RICHMOND ","state":"VA","zip":"23223-9998","dob":"1955-06-21","age":"","mstatus":"","insh":11013470,"cliId":"7UF9AN7VY32","pno":8047370169,"cno":8047370169,"email":"","ename":"","eno":"","pphy":"ANSARI, NATHER B  ","ppno":5407859900,"pcpadd":"1075 GARRISONVILLE RD,Ste 115","pcpcity":"STAFFORD ","pcpstate":"VA","pcpzip":225568600,"pcpcounty":"","pcpid":"P0060175","pcpname":"PRIMARY AND URGENT CARE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"N","ano":"","add2":"","add3":"","madd1":"P.O.BOX 853 ","madd2":"","madd3":"","mcity":"SANDSTON ","mstate":"VA","mzip":"23150-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M53.3","M10.041","R79.89","M10.9","M25.532","M25.522","S69.82XA","M77.02","M25.512","S46.812A","S16.1XXA","M54.5","M47.817","M54.31","M25.551","M25.521","M25.572","M1A.00X1","M1A.09X1","Z68.33","R20.2","Z68.32","H57.89","R73.03","F51.01","Z87.39","H04.123","H02.89","H25.13","H52.7","Z23","E79.0","Z00.00","E78.00","R10.9","K13.0","H61.20","S01.511A","R20.0","F41.9","S60.861A","W57.XXXA","M13.0","M25.561","M25.562","G89.29","N52.9","N40.1","R35.1","N43.40"],"date":["2020-07-23","2020-06-01","2021-02-08","2021-04-30","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-07-20","2020-07-20","2020-07-20","2021-07-19","2020-07-23","2020-07-23","2020-07-27","2020-08-18","2020-09-01","2020-09-01","2021-10-06","2021-02-08","2021-01-07","2021-10-06","2021-02-08","2021-10-12","2021-05-05","2021-10-12","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-04-17","2020-08-06","2021-10-12","2020-08-06","2020-08-06","2021-03-25","2021-03-25","2021-03-25","2021-05-05","2021-05-05","2021-07-19","2021-07-19","2021-07-13","2021-10-12","2021-10-12","2021-10-12","2021-10-19","2021-10-19","2020-08-31","2020-08-31"],"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":[["","254200801","COLCHICINE","TAB 0.6MG","","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","","Select","Select",""],["","832105415","BACLOFEN","TAB 10MG","","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","","Select","Select",""],["","172392570","DIAZEPAM","TAB 2MG","","Select","Select",""],["","13668000801","ZOLPIDEM","TAB 10MG","","Select","Select",""],["","16714004211","ALLOPURINOL","TAB 300MG","","Select","Select",""],["","70461012003","FLUAD QUADRI","INJ 0.5ML","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","59746000106","METHYLPRED","TAB 4MG","","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","","Select","Select",""],["","116200116","CHLORHEX GLU","SOL 0.0012","","Select","Select",""],["","832105415","BACLOFEN ","TAB 10MG","30","Select","Select",""],["","254200801","COLCHICINE ","TAB 0.6MG","90","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","16571020210","DICLOFENAC ","TAB 50MG DR","60","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","7","Select","Select",""],["","16714004211","ALLOPURINOL ","TAB 300MG","90","Select","Select",""],["","13668000805","ZOLPIDEM ","TAB 10MG","30","Select","Select",""],["","65162019011","NAPROXEN ","TAB 500MG","60","Select","Select",""],["","172392570","DIAZEPAM ","TAB 2MG","30","Select","Select",""],["","59746000106","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","68382005105","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","70461012003","FLUAD ","INJ 0.5ML","0.5","Select","Select",""],["","116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","59746017509","PREDNISONE","20MG","7","Select","Select",""],["","70461012003","FLUAD","0.5ML","0.5","Select","Select",""],["","00116200116","CHLORHEX","0.0012","473","Select","Select",""],["","45802006435","TRIAMCINOLON","0.001","15","Select","Select",""],["","45802006435","TRIAMCINOLON ","CRE 0.001","15","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":""}]}]}