{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GREGORY   G SEIFER","gend":0,"add":"2061 CREIGHTON ROAD","city":"RICHMOND","state":"VA","zip":"23223-4626","dob":"1961-09-07","age":"","mstatus":"","insh":10065180,"cliId":"","pno":8045645041,"cno":8046174005,"email":"","ename":"","eno":"","pphy":"JACKSON, RICHARD A","ppno":8042257148,"pcpadd":"304 E Leigh St, ","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232191410,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":8046174005,"add2":"                                                            ","add3":"","madd1":"2061 CREIGHTON ROAD","madd2":"                                                            ","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23223-4626","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C13.1","J43.9","Z48.3","C32.1","Z43.0","Z46.6","Z43.1","G80.9","C32.9","R33.9","Z93.1","Z93.0","R33.8","J38.7","C32.0","R06.89","D62","R13.10","Z90.02","R68.89","C32.8","Z72.0","C15.9","G89.3","G47.00","K59.00","R64","Z48.813","C77.0","R11.2","B37.9","Z87.891","E86.0","C77.9","Z79.899","R11.0","Z79.891","L59.9","R68.84","Z85.21","R60.0","M26.601","R23.8","H47.213","H52.13","H47.20","Z45.2","R06.00","R07.0","H92.09","R05","R22.1","I49.3","N39.0","K56.609","K56.50","K56.2","T81.32XA","Z98.890","R49.0","C32.2","J98.11","R14.0","B37.0","Z51.11","R10.30","R19.7","I49.9","R50.9","B34.9","F41.9","T83.098A","Z48.02","R63.4","R09.02","R06.02","Z20.828","G50.1","Z23","H47.293","H53.453","Z88.0","E03.9","Z13.31","Z68.29","I10","R89.9","Z92.29","Z68.1","E44.0","E87.1","F17.210","J44.9","Z79.51","J98.8","N28.1","K91.32","T83.511A","K94.23","Y83.9","Z68.20","B96.20","N43.3","Y84.6","Z80.9","K09.0","Z01.812","E46","K21.9","I95.9","E87.6","Z85.01","R00.0","R91.8","E83.42","R49.1","R79.9","R79.89","E55.9","E53.8","R53.1","K11.9","Z11.59","C76.0","J38.3","T83.030A","K56.52","D72.829","N20.0","K06.3","K05.323","K02.9","R59.0","J96.01","H53.9","H52.223","F32.9","F17.291","G50.0","Z92.3","Z92.21","Z79.1","Z68.24","I11.9","R63.3","G80.8","K57.90","K22.4","Z79.52","I25.10","Z08","R12","R52","J18.9","M25.559","R94.31","R35.1","H93.299","G93.89","Z20.822","T83.030D","M27.40","Z42.8","I60.9","G93.2","J15.212","R51","R07.9","J39.2","D49.0","K56.600","Z48.89","Z04.9"],"date":["2019-07-06","2019-07-08","2020-01-21","2021-04-21","2021-03-26","2019-09-06","2020-10-28","2021-04-21","2021-04-20","2019-08-28","2020-04-09","2020-09-15","2019-08-14","2020-01-10","2020-01-21","2019-09-20","2019-09-24","2020-09-15","2020-03-06","2021-04-20","2021-04-22","2021-04-22","2021-04-21","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2019-11-22","2020-10-08","2019-12-20","2020-01-09","2021-04-21","2019-12-20","2019-12-03","2020-10-08","2020-04-09","2020-03-06","2019-12-21","2020-05-11","2021-03-26","2020-07-23","2020-08-10","2020-08-10","2021-02-08","2020-10-26","2021-04-08","2021-04-21","2019-12-21","2019-07-06","2019-07-06","2020-07-30","2019-07-06","2019-09-18","2019-07-21","2020-01-27","2019-07-22","2019-07-22","2019-07-22","2019-07-22","2019-08-20","2019-09-18","2020-02-28","2019-09-20","2019-11-26","2019-11-06","2019-11-24","2019-12-19","2019-12-23","2019-12-23","2019-12-23","2020-07-28","2019-07-18","2019-08-21","2020-08-13","2019-09-21","2020-07-30","2020-08-12","2020-09-01","2020-09-22","2020-11-03","2020-11-03","2021-04-21","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2019-09-18","2019-07-21","2019-07-06","2019-07-06","2019-07-06","2019-07-06","2019-07-21","2019-07-21","2019-07-21","2019-07-21","2019-07-21","2019-07-21","2019-07-21","2019-07-21","2019-07-21","2019-07-21","2019-07-21","2019-08-16","2019-09-05","2019-09-18","2019-11-04","2019-09-18","2019-09-23","2020-09-01","2019-09-18","2020-07-30","2019-09-24","2020-02-10","2020-07-10","2021-03-16","2021-03-16","2021-03-16","2020-08-13","2020-08-29","2021-02-22","2021-04-19","2019-07-06","2019-07-18","2019-07-22","2019-09-26","2019-07-30","2019-08-12","2019-08-12","2021-01-11","2019-08-13","2019-09-21","2019-10-17","2019-10-17","2019-11-15","2019-11-15","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2021-03-16","2021-03-16","2019-07-11","2019-07-21","2019-10-03","2019-10-03","2019-12-12","2020-02-28","2020-04-09","2020-04-09","2020-04-09","2020-07-30","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2021-01-18","2021-04-19","2019-07-18","2019-08-16","2019-09-18","2019-09-22","2019-09-22","2019-09-22","2020-06-26","2020-07-30","2019-07-06","2019-07-06","2019-07-29","2019-09-18","2019-12-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","65862059805","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","60505024801","MIRTAZAPINE ","TAB 30MG","30","Select","Select",""],["","65862039110","ONDANSETRON ","TAB 8MG ODT","30","Select","Select",""],["","42858000201","OXYCODONE ","TAB 10MG","120","Select","Select",""],["","50383070016","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","63868025710","NAT ","TAB 8.6MG","60","Select","Select",""],["","42858080101","MORPHINE ","TAB 15MG ER","60","Select","Select",""],["","51991096158","POLYETH ","POW 3350 NF","238","Select","Select",""],["","47781066290","LEVOTHYROXIN ","TAB 150MCG","30","Select","Select",""],["","27241009903","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","69618004410","DOCUSATE ","CAP 100MG","60","Select","Select",""],["","45802095243","IBUPROFEN ","SUS 100\/5ML","600","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","69543038130","OLANZAPINE ","TAB 5MG","14","Select","Select",""],["","60432053716","NYSTATIN ","SUS 100000","140","Select","Select",""],["","00378511001","PROCHLORPER ","TAB 10MG","21","Select","Select",""],["","45802075830","PROMETHAZINE ","SUP 12.5MG","12","Select","Select",""],["","55111068405","IBU ","TAB 800MG","90","Select","Select",""],["","54838010780","SILACE ","SYP 60\/15ML","0.44","Select","Select",""],["","65862049647","SMZ-TMP ","SUS 200-40\/5","280","Select","Select",""],["","69315090501","LORAZEPAM ","TAB 1MG","30","Select","Select",""],["","40985027087","MELATONIN ","TAB MAX ST","90","Select","Select",""],["","43547039910","CYCLOBENZAPR ","TAB 5MG","10","Select","Select",""],["","00054418425","DEXAMETHASON ","TAB 4MG","36","Select","Select",""],["","00000000000",""," ","480","Select","Select",""],["","67877019990","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","59762503001","FLUCONAZOLE ","SUS 40MG\/ML","35","Select","Select",""],["","60505003306","PENTOXIFYLLI ","TAB 400MG ER","60","Select","Select",""],["","69618001110","ACETAMINOPHN ","TAB 500MG","120","Select","Select",""],["","59746017506","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","00832059011","DIPHEN\/ATROP ","TAB ","10","Select","Select",""],["","00781278531","OMEPRAZOLE ","CAP 10MG","30","Select","Select",""],["","00115146845","LIDO\/PRILOCN ","CRE 2.5-2.5%","30","Select","Select",""],["","00904685260","LORATADINE ","TAB 10MG","30","Select","Select",""],["","54162000708","SENNA-GRX ","SYP 8.8MG\/5","119","Select","Select",""],["","00536589488","NICOTINE ","DIS 7MG\/24HR","14","Select","Select",""],["","33342002332","LEVOFLOXACIN ","TAB 750MG","7","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","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}