{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AETIUS   R LAWRENCE","gend":0,"add":"6024 JAHNKE ROAD","city":"RICHMOND","state":"VA","zip":"23225-9998","dob":"1957-06-24","age":"","mstatus":"","insh":"900039528*01","cliId":"6CW8EU1DQ47","pno":"804\/658-4594","cno":"804\/658-4594","email":"","ename":"","eno":"","pphy":"PENDYAL, KAUSALYA MD","ppno":"804\/560-0490","pcpadd":"SUITE 4 681 HIOAKS ROAD","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23225,"pcpcounty":"","pcpid":149263,"pcpname":"Primary Health Group - Chippenham","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/560-3424","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R39.81","G40.89","D72.829","E22.2","E87.2","G40.802","R41.82","R09.89","R56.9","E87.1","E16.2","R13.10","I50.30","G93.40","G40.909","F03.90","G20.","G40.209","R55.","D69.6","R07.89","R26.9","I10.","I82.409","G40.901","R41.89","I24.8","I82.401","R05.","Z79.01","Z86.718","Z91.81","T17.398A","G40.919","W06.XXXA","R51.9","R03.0","Z09.","R13.12","R00.0","R53.81","I82.449","R26.2","R41.841","Z91.14","R22.43","I80.221","I51.7","R79.89","Z20.828","F02.80","Z79.1","R00.2","R42.","H54.7","M62.82","I42.9","Z79.2","R60.0","R26.89","R90.82","G40.401","Z20.822","G91.9","Z76.89","I34.0","N39.41","N39.44","R39.15","R94.31","S09.93XA","R53.1","G40.409","I69.351","I82.4Z9","R33.9","R45.87","D64.9","R09.01","H52.203","H25.813","H34.8312","H40.003","E86.0","D53.9","N40.1","R33.8","Z86.69","S62.323A","M79.642","S62.323D","H02.871","H35.013","H35.9","R31.0","G93.41"],"date":["2020-09-14","2020-09-14","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2021-05-14","2020-08-15","2021-05-20","2020-12-04","2021-04-05","2021-04-11","2020-10-05","2020-10-05","2021-07-21","2020-12-03","2020-12-03","2021-11-17","2021-03-29","2021-05-15","2021-03-29","2021-04-16","2021-05-17","2021-07-21","2021-06-02","2021-05-17","2020-09-01","2020-08-25","2020-09-01","2021-05-17","2021-05-15","2020-10-05","2020-10-07","2021-07-19","2020-12-03","2021-03-15","2021-03-15","2021-06-02","2021-05-17","2021-07-21","2020-08-24","2020-08-24","2020-08-24","2021-04-07","2020-08-24","2020-08-25","2020-10-20","2021-03-31","2020-08-19","2020-12-03","2020-12-03","2020-12-03","2021-03-15","2021-05-20","2021-03-16","2020-08-15","2020-08-15","2020-08-15","2020-08-15","2020-08-15","2020-12-03","2021-05-17","2021-05-15","2021-04-05","2020-06-01","2020-08-19","2021-11-05","2021-11-05","2021-11-05","2020-08-15","2020-08-15","2021-04-07","2021-05-15","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2021-05-16","2021-04-13","2021-04-28","2021-09-24","2021-04-28","2021-09-24","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-16","2021-10-22","2021-06-22","2021-08-25","2021-06-16","2021-07-26","2021-09-24","2021-11-05","2020-08-15"],"priorHcc":["","","","","","","","","","","","","","","","","",null,"",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":[]},{"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":[["","16714035701","LEVETIRACETA","TAB 1000MG","90","Select","Select",""],["","62756018418","OXCARBAZEPIN","TAB 300MG","30","Select","Select",""],["","69097086107","ZONISAMIDE","CAP 100MG","60","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","3089421","ELIQUIS","TAB 5MG","180","Select","Select",""],["","62756079813","DIVALPROEX","TAB 500MG DR","60","Select","Select",""],["","378001805","METOPROL TAR","TAB 25MG","90","Select","Select",""],["","50474050015","NAYZILAM","SPR 5MG","-2","Select","Select",""],["","11917017980","MULTIVITAMIN","TAB MEN 50+","90","Select","Select",""],["","904672559","SENNA","TAB 8.6MG","30","Select","Select",""],["","62756018318","OXCARBAZEPINE ","","180","Select","Select",""],["","378001805","METOPROLOL TARTRATE","","-270","Select","Select",""],["","68180011507","LEVETIRACETAM ","","60","Select","Select",""],["","16714048502","DIVALPROEX SODIUM ER ","","120","Select","Select",""],["","3089421","ELIQUIS ","","180","Select","Select",""],["","16714071302","TAMSULOSIN HYDROCHLORIDE","","90","Select","Select",""],["","62756079813","DIVALPROEX SODIUM DR ","","180","Select","Select",""],["","11917017980","MULTIVITAMIN MEN 50+ ","","90","Select","Select",""],["","62756018318","OXCARBAZEPINE","","180","Select","Select",""],["","16714035601","LEVETIRACETAM","","120","Select","Select",""],["","16714048502","DIVALPROEX SODIUM ER","","120","Select","Select",""],["","62756079813","DIVALPROEX SODIUM DR","","60","Select","Select",""],["","11917017980","MULTIVITAMIN MEN 50+","","100","Select","Select",""],["","70069023101","BRIMONIDINE TARTRATE","0.2% OP","15","Select","Select",""],["","16714048502","DIVALPROEX SODIUM ER                                                  ","TAB 500MG ER","120","Select","Select",""],["","62756018318","OXCARBAZEPINE                                                         ","TAB 150MG","180","Select","Select",""],["","00378001805","METOPROLOL TARTRATE                                                   ","TAB 25MG","-90","Select","Select",""],["","68180011507","LEVETIRACETAM                                                         ","TAB 1000MG","-60","Select","Select",""],["","62756079813","DIVALPROEX SODIUM DR                                                  ","TAB 500MG DR","-180","Select","Select",""],["","16714071302","TAMSULOSIN HYDROCHLORIDE                                              ","CAP 0.4MG","90","Select","Select",""],["","00003089421","ELIQUIS                                                               ","TAB 5MG","180","Select","Select",""],["","50474050015","NAYZILAM                                                              ","SPR 5MG","2","Select","Select",""],["","11917017980","MULTIVITAMIN MEN 50+                                                  ","TAB MEN 50+","90","Select","Select",""],["","69097086107","ZONISAMIDE                                                            ","CAP 100MG","-60","Select","Select",""],["","00904672559","SENNA                                                                 ","TAB 8.6MG","30","Select","Select",""],["","70069023101","BRIMONIDINE TARTRATE                                                  ","SOL 0.2% OP","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":[[["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":""}]}]}