{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FRANKLIN RICHARDSON","gend":0,"add":"611 KATES TRACE CIRCLE APT E  ","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1961-07-20","age":"","mstatus":"","insh":11014958,"cliId":"7DY9V29CA18","pno":7575270200,"cno":7575270200,"email":"","ename":"","eno":"","pphy":"BAGNALL, RICHARD D","ppno":7573452555,"pcpadd":"120 Kings Way Ste 1400","pcpcity":"Williamsburg","pcpstate":"VA","pcpzip":231852508,"pcpcounty":"","pcpid":"P9059023","pcpname":"RIVERSIDE WILLIAMSBURG FAMILY MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"611 KATES TRACE CIRCLE APT E  ","madd2":"","madd3":"","mcity":"NEWPORT NEWS","mstate":"VA","mzip":"23608-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M16.11","M51.36","M51.37","M48.061","E66.09","Z68.32","M48.07","I10","E78.2","F32.5","M46.96","M48.062","M17.0","I63.512","G81.91","D64.9","F20.9","F31.9","G89.4","I48.0","R29.705","R29.810","R47.01","R73.03","Z93.3","I63.89","I66.02","I67.2","E78.5","Z86.73","I63.9","Z74.3","R29.818","I44.1","I45.10","J81.1","Z09","M79.2","R53.1","I69.351","I69.320","E11.9","G47.33","M19.90","Z79.01","Z79.84","R00.1","R26.2","R27.8","R29.898","I69.322","M25.671","M25.672","M25.571","M25.572","F31.70","M19.071","M19.072","M21.41","M21.42","R26.89","M79.671","M79.672","M19.079","R51.9","I48.91","R47.89","K42.9","B35.1","F33.0","G47.00","N40.0","Z79.82","E66.9","Z68.38","M54.17","M54.16","K43.0","F11.90","K57.90","R54","Z00.00","Z11.59","K43.2","Z91.81","Z12.5","L60.2","Z71.89","I63.312","G43.809","K43.9","K57.30","N28.1","I44.0","H25.13","H40.013","H52.13","H52.223","H52.4","Z90.49","Z79.899","Z68.31"],"date":["2021-11-04","2020-08-14","2021-11-04","2020-08-14","2021-06-11","2020-10-09","2020-09-10","2021-07-15","2021-07-15","2020-12-10","2020-10-09","2020-10-09","2020-10-09","2020-12-01","2020-12-01","2020-12-16","2020-12-01","2021-06-11","2021-11-04","2021-09-27","2020-12-01","2020-12-01","2020-12-01","2021-07-15","2020-12-01","2020-12-02","2020-12-01","2020-12-01","2020-12-16","2021-07-15","2021-04-05","2020-12-01","2020-12-02","2021-07-15","2021-09-27","2020-12-01","2020-12-02","2021-07-15","2020-12-08","2020-12-16","2020-12-16","2021-11-18","2021-07-15","2020-12-16","2021-06-17","2021-11-18","2021-01-29","2021-04-07","2021-04-07","2021-04-07","2021-04-05","2021-02-16","2021-02-16","2021-02-22","2021-02-22","2020-12-01","2021-02-22","2021-02-22","2021-09-30","2021-09-30","2021-02-22","2021-04-05","2021-04-05","2021-02-22","2021-02-25","2021-10-25","2021-04-05","2021-05-27","2021-09-30","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2021-11-04","2021-06-10","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-07-15","2021-07-15","2021-10-25","2021-07-15","2021-07-15","2021-09-30","2021-07-15","2021-06-28","2021-06-28","2021-09-09","2021-09-09","2021-09-09","2021-09-27","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-10-25","2021-10-25","2021-10-25"],"priorHcc":[null,"",null,"","","","","","","","","","","","","","","",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":[["","55111012305","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","406052301","OXYCOD\/APAP","TAB 10-325MG","","Select","Select",""],["","68382080501","TRAZODONE","TAB 50MG","","Select","Select",""],["","50458057930","XARELTO","TAB 20MG","","Select","Select",""],["","27241000306","RISPERIDONE","TAB 0.5MG","","Select","Select",""],["","51224000760","METFORMIN","TAB 500MG ER","","Select","Select",""],["","65862059801","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","","Select","Select",""],["","16729017001","ESCITALOPRAM","TAB 20MG","","Select","Select",""],["","378451793","AMLOD\/ATORVA","TAB 10-10MG","","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","","Select","Select",""],["","57664047758","METOPROL TAR","TAB 50MG","","Select","Select",""],["","406052301","OXYCOD\/APAP ","TAB 10-325MG","42","Select","Select",""],["","68382080501","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","27241000306","RISPERIDONE ","TAB 0.5MG","30","Select","Select",""],["","51224000760","METFORMIN ","TAB 500MG ER","30","Select","Select",""],["","55111012305","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","16729017001","ESCITALOPRAM ","TAB 20MG","30","Select","Select",""],["","50458057930","XARELTO ","TAB 20MG","90","Select","Select",""],["","65862059801","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","68382005101","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","65162010150","GABAPENTIN ","CAP 100MG","30","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","90","Select","Select",""],["","57664047758","METOPROL ","TAB 50MG","90","Select","Select",""],["","378451793","AMLOD\/ATORVA ","TAB 10-10MG","5","Select","Select",""],["","172409660","BACLOFEN ","TAB 10MG","30","Select","Select",""],["","69097073102","TERBINAFINE ","250MG","30","Select","Select",""],["","57664047758","METOPROL","50MG","90","Select","Select",""],["","00172409660","BACLOFEN","10MG","30","Select","Select",""],["","69097073102","TERBINAFINE","250MG","30","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","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","",""],["Yes","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":""}]}]}