{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LENA   R JACKSON","gend":1,"add":"7761 BELASCO DR APT B","city":"RICHMOND","state":"VA","zip":"23225-9998","dob":"1977-01-25","age":"","mstatus":"","insh":"900034836*01","cliId":"","pno":"804\/767-0110","cno":"","email":"","ename":"","eno":"","pphy":"VAN AUKEN, JESSICA L NP","ppno":"866\/765-7130","pcpadd":"12787 BOOKER T WASHINGTON HWY STE 1","pcpcity":"HARDY","pcpstate":"VA","pcpzip":24101,"pcpcounty":"","pcpid":"","pcpname":"BRADLEY J GOAD","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"201\/228-9980","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G72.41","J44.9","Z93.0","Z99.11","Z99.81","R32.","R39.81","G71.0","R91.8","R06.02","G71.9","Z91.81","I10.","F32.9","I48.91","K58.9","Z74.09","R07.89","R60.0","J96.10","Z01.818","N81.10","F41.8","I47.1","J45.991","G71.00","R07.9","I48.0","Z01.810","Z98.890","G47.30","R03.0","Z68.42","I50.9","J96.11","E87.3","I48.92","R41.82","R00.0","J96.02","A04.72","J90.","A49.8","Z87.01","G72.9","J18.9","Z79.899","J96.12","J45.909","G47.39","R13.10","Z79.51","J30.9","J96.90","F39.","G12.21","Z00.00","A60.00","D64.9","M79.89","Z12.31","Z03.818","I73.9","R53.1","G47.10","R52.","R26.2","Z01.812","I20.0","R06.00","J98.11","E66.9","R00.1","Z43.0","Z68.37","R06.89","J98.4","G81.00","R13.12","R68.89","Z72.89","Z99.3","Z68.43","E66.01","M62.81","R29.3","Z51.89","G47.31","Z86.19","F41.9","M62.838","I87.2","G47.33","K80.20","B37.2","R76.8","G89.29","K21.9","L29.9","J96.21","T17.990A","E16.2","E87.6","Z88.8","R40.4","Z74.3","Z68.41","Z53.29","G70.9","I27.20","J20.9","M54.5","M62.830","R10.9","R53.81","I11.0","J96.20","I50.33","G71.09","I51.7","R60.9","Z23.","R05.","Z74.01","J96.00","R19.7","R06.03","J95.03","H61.23","J01.00","Z20.828","M79.662","M25.522","M60.9","R73.09","R79.89","Z13.21","E55.9","E11.9","R60.1","G71.29","F32.A","Z71.89","S31.829A","S31.819A","Z71.9","R09.02","I50.32","R49.0","Z87.39","Z20.822","L73.8","L21.9","M79.602","M79.605","R27.9","Z11.52","B35.1","Y71.0","I49.9","G93.40","R79.81","T14.90XA","H61.22","H91.92","R00.2","Z68.38","T17.890A","N39.44","N39.3","N39.0","S46.819A","R53.83","H10.9","L73.9","H90.A32","H69.80","E66.2","G35.","R63.3","H90.A11","Q79.1","L30.9","H10.13","Z46.89","R26.81","W19.XXXA","S39.91XA","S39.93XA","S79.912A","M25.462","S59.902A","L68.0","N92.6","Z46.82","M25.572","M25.552","Z68.36","R51.","Z92.29","A41.9","Z91.89"],"date":["2021-12-04","2021-12-04","2021-12-04","2021-12-04","2021-10-25","2020-07-14","2020-10-12","2020-02-10","2019-06-07","2021-03-31","2020-02-10","2020-10-13","2021-10-25","2021-06-22","2021-10-25","2021-10-25","2020-02-10","2020-01-09","2021-09-03","2021-12-08","2019-10-16","2019-10-22","2021-06-01","2021-10-25","2020-07-15","2021-12-08","2019-09-20","2021-03-31","2019-10-22","2019-10-10","2021-03-31","2020-05-07","2021-11-30","2020-08-13","2021-10-25","2019-12-09","2019-12-09","2020-01-09","2019-12-15","2020-01-09","2020-02-25","2020-01-04","2020-01-08","2020-02-17","2021-08-31","2020-02-18","2021-11-30","2021-10-25","2021-10-25","2021-10-25","2021-04-21","2020-05-04","2021-10-13","2020-10-13","2021-02-14","2021-02-22","2021-06-17","2021-06-01","2021-08-18","2021-06-01","2021-10-26","2021-09-23","2021-10-07","2021-10-07","2019-08-27","2020-08-13","2021-02-14","2019-10-22","2019-11-11","2019-11-11","2021-05-13","2021-04-21","2020-01-09","2021-11-30","2020-01-09","2020-02-23","2020-08-19","2021-02-14","2021-09-03","2021-04-21","2021-04-21","2021-10-25","2021-04-21","2021-12-08","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-10-25","2021-09-03","2021-10-07","2018-12-27","2019-12-16","2019-05-14","2020-04-24","2020-04-24","2020-04-24","2019-05-14","2020-08-19","2019-12-05","2019-12-05","2019-12-15","2019-12-05","2019-12-05","2021-05-13","2020-05-07","2019-12-15","2019-12-15","2019-12-15","2018-12-18","2020-04-24","2018-12-18","2021-05-13","2021-02-13","2021-05-13","2019-12-15","2019-09-18","2019-09-18","2019-09-18","2021-12-08","2020-09-29","2019-12-05","2020-01-23","2019-12-31","2019-12-31","2020-01-22","2020-02-23","2021-06-07","2020-04-24","2020-08-14","2021-05-13","2021-05-13","2021-06-21","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-10-07","2021-10-25","2021-10-25","2020-02-12","2020-06-17","2020-06-17","2020-07-15","2020-08-18","2021-02-13","2021-02-13","2021-02-13","2021-06-17","2021-03-05","2021-03-05","2021-05-14","2021-05-14","2021-05-14","2021-06-17","2021-10-07","2019-09-10","2019-09-18","2019-12-06","2020-03-03","2021-05-13","2021-08-26","2021-08-26","2019-04-05","2019-04-05","2019-06-07","2019-10-23","2019-10-23","2019-10-23","2020-08-13","2021-06-17","2021-01-29","2021-03-05","2021-06-07","2021-06-07","2019-12-15","2020-02-23","2021-04-21","2021-06-07","2020-02-23","2020-09-02","2020-09-02","2020-10-13","2020-10-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-06-17","2021-06-17","2021-11-30","2019-05-17","2019-05-17","2019-05-17","2019-07-17","2019-09-25","2019-12-15","2019-12-15"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00378623301","CITALOPRAM HYDROBROMIDE                                               ","40MG","30","Select","Select",""],["","62037083001","METOPROLOL SUCCINATE ER                                               ","25MG ER","90","Select","Select",""],["","00378427577","VALACYCLOVIR HYDROCHLORIDE                                            ","500MG","-30","Select","Select",""],["","31722072690","MONTELUKAST SODIUM                                                    ","10MG","15","Select","Select",""],["","00245036030","KLOR-CON                                                              ","20MEQ","30","Select","Select",""],["","65162062711","TRAMADOL HCL                                                          ","50MG","56","Select","Select",""],["","00172572860","FAMOTIDINE                                                            ","20MG","-30","Select","Select",""],["","70010075401","METHOCARBAMOL                                                         ","500MG","-45","Select","Select",""],["","00054429931","FUROSEMIDE                                                            ","40MG","15","Select","Select",""],["","00363070102","ACID CONTROLLER MAXIMUM STRENGTH                                      ","20MG","30","Select","Select",""],["","00378827052","ALBUTEROL SULFATE                                                     ","0.08%","75","Select","Select",""],["","65862044990","VALACYCLOVIR HCL                                                      ","1GM","-90","Select","Select",""],["","69097084905","ESCITALOPRAM OXALATE                                                  ","20MG","90","Select","Select",""],["","00591079401","DICYCLOMINE HYDROCHLORIDE                                             ","10MG","45","Select","Select",""],["","43598081115","CETIRIZINE HYDROCHLORIDE                                              ","10MG","90","Select","Select",""],["","00093101042","MUPIROCIN                                                             ","2%","22","Select","Select",""],["","57237002801","AMOXICILLIN                                                           ","500MG","-20","Select","Select",""],["","45802046564","KETOCONAZOLE                                                          ","2%","120","Select","Select",""],["","00574200802","NYSTOP                                                                ","100000","60","Select","Select",""],["","50580072632","ZYRTEC ALLERGY                                                        ","10MG","90","Select","Select",""],["","00093314705","CEPHALEXIN                                                            ","500MG","30","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE                                                ","50MCG","-16","Select","Select",""],["","65162083366","DICLOFENAC SODIUM                                                     ","1%","100","Select","Select",""],["","11917006885","LATEX GLOVES ONE SIZE                                                 ","ONE SIZE","50","Select","Select",""],["","00713022615","TRIAMCINOLONE ACETONIDE                                               ","0.03%","45","Select","Select",""],["","61314030802","AZELASTINE HCL                                                        ","0.05%","6","Select","Select",""],["","70069013101","TOBRAMYCIN                                                            ","0.3% OP","5","Select","Select",""],["","11523720006","CLARITIN                                                              ","10MG","30","Select","Select",""],["","51672130009","AMMONIUM LACTATE                                                      ","12%","400","Select","Select",""],["","45802031834","BENZOYL PEROXIDE WASH                                                 ","10% WASH","227","Select","Select",""],["","00378345823","AZELASTINE HYDROCHLORIDE\/FLUTICASONE PROPIONATE                       ","137-50","23","Select","Select",""],["","45802065087","LORATADINE                                                            ","10MG","30","Select","Select",""],["","68180031909","BUPROPION HYDROCHLORIDE ER (XL)                                       ","150MG XL","90","Select","Select",""],["","00378967130","IPRATROPIUM BROMIDE\/ALBUTEROL SULFATE                                 ","ALBUTER","90","Select","Select",""],["","00006483703","PNEUMOVAX 23                                                          ","25\/0.5","0","Select","Select",""],["","0","                                                                      ","","240","Select","Select",""],["","53489011905","DOXYCYCLINE HYCLATE                                                   ","100MG","20","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}