{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"IDA MCKENSIE","gend":1,"add":"19714 ALBERT DRIVE","city":"DINWIDDIE","state":"VA","zip":"23841-9998","dob":"1935-08-21","age":"","mstatus":"","insh":11017323,"cliId":"7XC0FX1QR23","pno":8044694371,"cno":8045903963,"email":"","ename":"","eno":"","pphy":"HOLLAND, JOHN A","ppno":4346962165,"pcpadd":"1508 K V Rd","pcpcity":"Victoria ","pcpstate":"VA","pcpzip":239742624,"pcpcounty":"","pcpid":"P0060188","pcpname":"DINWIDDIE MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"19714 ALBERT DRIVE","madd2":"","madd3":"","mcity":"DINWIDDIE","mstate":"VA","mzip":"23841-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R06.00","I50.9","I83.813","I10","Z11.59","R05","I51.7","I34.0","I36.1","M79.604","M79.605","Z20.822","R06.02","R94.39","I42.9","I25.10","I25.119","R07.9","E66.9","Z68.41","D64.9","R73.03","E55.9","I50.22","R60.9","I42.8","E66.3","F32.9","Z23","F41.9","R73.9","N17.9","N39.0","J45.40","J30.9","K21.9","R41.82","G93.41","F33.1","M62.82","E11.9","E78.5","E86.0","E87.6","G89.29","I11.0","I49.1","J44.9","R53.1","I67.2","N81.6","A41.9","Z68.38","E87.1","R31.9","H25.11","H35.3131","Z96.1","J18.9","K80.20","R59.0","Z01.818","H26.9","S81.801A","S81.802A","Z68.39","F41.8","L97.211","R60.0","R54","R00.1","I35.1","H40.013","T78.40XA","J45.909"],"date":["2021-02-05","2021-11-05","2021-02-05","2021-11-05","2021-02-23","2021-06-28","2021-08-17","2021-10-29","2021-10-29","2021-02-05","2021-02-05","2021-02-23","2021-08-31","2021-03-01","2021-03-08","2021-10-22","2021-03-08","2021-03-08","2021-09-20","2021-03-08","2021-11-05","2021-03-19","2021-03-19","2021-06-28","2021-07-30","2021-10-07","2021-10-07","2021-09-20","2021-09-20","2021-08-17","2021-11-05","2021-08-25","2021-10-05","2021-09-10","2021-09-10","2021-09-10","2021-08-17","2021-10-05","2021-08-19","2021-10-05","2021-11-05","2021-08-17","2021-08-17","2021-08-25","2021-08-17","2021-10-05","2021-08-17","2021-08-17","2021-08-19","2021-08-17","2021-08-25","2021-08-17","2021-07-30","2021-08-17","2021-08-17","2021-10-12","2021-11-05","2021-11-05","2021-08-31","2021-08-31","2021-08-31","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-08-19","2021-10-05","2021-10-22","2021-10-22","2021-10-29","2021-10-29","2021-11-05","2021-10-12","2021-10-12"],"priorHcc":["",null,"",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":[["","68645055354","LISINOPRIL","TAB 20MG","","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","68645055154","LISINOPRIL ","TAB 5MG","90","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","43547040111","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","68382009205","CARVEDILOL ","3.125MG","60","Select","Select",""],["","00173088710","TRELEGY ","ELLIPTA","60","Select","Select",""],["","31722070190","LOSARTAN ","50MG","30","Select","Select",""],["","43598050930","ESOMEPRA ","20MG DR","30","Select","Select",""],["","00173088710","TRELEGY","ELLIPTA","60","Select","Select",""],["","43598050930","ESOMEPRA","20MG DR","30","Select","Select",""],["","68382009205","CARVEDILOL","3.125MG","60","Select","Select",""],["","31722070190","LOSARTAN","50MG","30","Select","Select",""],["","42806031250","DOXYCYCL","100MG","20","Select","Select",""],["","60505058204","MOXIFLOXACIN","HCL 0.5%","3","Select","Select",""],["","00065924007","DUREZOL","0.05%","5","Select","Select",""],["","13668000901","CITALOPRAM","10MG","30","Select","Select",""],["","60505058204","MOXIFLOXACIN ","SOL HCL 0.5%","3","Select","Select",""],["","42806031250","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","13668001001","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","00065924007","DUREZOL ","EMU 0.0005","5","Select","Select",""],["","31722052001","HYDRALAZINE ","TAB 25MG","180","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":""}]}]}