Summary Table
Categories |
Total Count |
PII |
0 |
URL |
0 |
DNS |
0 |
EKL |
0 |
IP |
0 |
PORT |
0 |
VsID |
0 |
CF |
0 |
AI |
0 |
VPD |
0 |
PL |
0 |
Other |
0 |
File Content
{
"site" : {
"siteName" : "HINES VAMC",
"stationNumber" : "578"
},
"oneVAStatus" : "TEST STATUS",
"eligibility" : {
"code" : "Service Connected 50% to 100%",
"status" : "Verified",
"serviceConnected" : true,
"serviceConnectedPercentage" : 40,
"rxPatientStatus" : "SC",
"combatVetEndDate" : "11/15/2019",
"unemployable" : "No",
"permanentTotalDisabled" : "Yes",
"currentMeansTestStatus" : "Required",
"medCopayExemptionStatus" : "EXEMPT"
},
"disabilities" : [{
"ratedDisability" : "Loss of Arm",
"disabilityPercentage" : 75,
"isServiceConnected" : true
},
{
"ratedDisability" : "Back Condition",
"disabilityPercentage" : 40,
"isServiceConnected" : false
},
{
"ratedDisability" : "Bursitis"
}
],
"patientCareTeams" : [{
"name" : "Gold Team",
"purpose" : "Primary Care",
"contactDetails" : {
"phone" : "123-123-1234",
"type" : "Pager"
},
"primaryCareProvider" : {
"name" : "PROVIDER, ONE",
"contactDetails" : {
"phone" : "123-123-1111"
}
},
"mentalHealthTeamCoordinator" : {
"name" : "NURSE, FOUR",
"contactDetails" : {
"phone" : "123-123-8888",
"pager" : "88888"
}
},
"mentalHealthTeamName" : "Blue Team",
"mentalHealthTeamContactDetails" : {
"phone" : "123-123-9999"
},
"facility" : {
"siteName" : "HINES VAMC",
"stationNumber" : "578"
},
"assignedDate" : "2001-01-01T09:09:09-05:00",
"teamPositions" : [{
"name" : "PROVIDER, ONE",
"contactDetails" : {
"phone" : "123-123-1111",
"pager" : "11111"
},
"role" : "Primary Care Provider",
"status" : "ACTIVE",
"facility" : {
"siteName" : "HINES VAMC",
"stationNumber" : "578"
}
},
{
"name" : "SMITH, TEST",
"contactDetails" : {
"phone" : "123-123-2222",
"pager" : "22222"
},
"role" : "Care Manager",
"status" : "ACTIVE",
"facility" : {
"siteName" : "HINES VAMC",
"stationNumber" : "578"
}
},
{
"name" : "PHARMACIST, ONE",
"contactDetails" : {
"phone" : "123-123-3333",
"pager" : "33333"
},
"role" : "Clinical Pharmacist",
"status" : "ACTIVE",
"facility" : {
"siteName" : "HINES VAMC",
"stationNumber" : "578"
}
}]
},
{
"name" : "Blue Team",
"purpose" : "Mental Health Treatment",
"contactDetails" : {
"phone" : "123-123-9999",
"pager" : "99999"
},
"facility" : {
"siteName" : "TEST CARE TEAM FAC",
"stationNumber" : "222"
},
"assignedDate" : "2001-01-01T09:09:09-05:00",
"teamPositions" : [{
"name" : "NURSE, FOUR",
"contactDetails" : {
"phone" : "123-123-8888",
"pager" : "88888"
},
"role" : "Mental Health Treatment Coordinator",
"status" : "ACTIVE",
"facility" : {
"siteName" : "HINES VAMC",
"stationNumber" : "578"
}
}]
},
{
"name" : "PTSD Team",
"purpose" : "Primary Care",
"contactDetails" : {
"phone" : "123-222-1234",
"pager" : "12225"
},
"primaryCareProvider" : {
"name" : "PROVIDER, SEVEN",
"contactDetails" : {
"phone" : "123-123-7777"
}
},
"facility" : {
"siteName" : "NORTH CHICAGO VAMC",
"stationNumber" : "556"
},
"assignedDate" : "2001-01-01T09:09:09-05:00",
"teamPositions" : [{
"name" : "PROVIDER, THREE",
"contactDetails" : {
"phone" : "123-222-1111",
"pager" : "12221"
},
"role" : "Primary Care Provider",
"status" : "ACTIVE",
"facility" : {
"siteName" : "NORTH CHICAGO VAMC",
"stationNumber" : "556"
}
}]
}],
"contactDetails" : {
"phone" : "987-654-1111",
"pager" : "98765",
"fax" : "987-654-1112",
"email" : "SMITHR@GMAIL.COM",
"mobile" : "987-654-1113",
"home" : "987-654-1114",
"temporary" : "123-456-9999",
"confidential" : "123-456-8888",
"other" : "987-654-1115"
},
"permanentAddress" : {
"address" : {
"street" : "7500 LINCOLN WAY",
"streetLine2" : "UNIT 508",
"streetLine3" : "BLDG #5",
"city" : "HERMITAGE",
"state" : "TN",
"zip" : "37076",
"county" : "DAVIDSON (037)",
"country" : "UNITED STATES"
},
"badAddressIndicator" : "UNDELIVERABLE"
},
"temporaryAddress" : {
"address" : {
"street" : "6309 SUN DRIVE",
"streetLine2" : "PRESIDENTIAL BLDG",
"streetLine3" : "UNIT 309",
"city" : "HERMITAGE",
"state" : "TN",
"zip" : "37076",
"county" : "DAVIDSON (037)",
"country" : "UNITED STATES"
},
"active" : "true",
"fromDate" : "2001-01-02T01:01:00-05:00",
"toDate" : "2002-02-02T02:02:09-05:00"
},
"confidentialAddress" : {
"address" : {
"street" : "6666 SUN DRIVE",
"streetLine2" : "BLDG X",
"streetLine3" : "UNIT 666",
"city" : "HERMITAGE",
"state" : "TN",
"zip" : "37076",
"county" : "DAVIDSON",
"country" : "UNITED STATES"
},
"active" : "true",
"fromDate" : "2003-03-03T03:03:09-05:00",
"toDate" : "2004-04-04T04:04:09-05:00",
"confidentialAddressCategories" : [
"COPAYMENTS/VETERAN BILLING",
"TEST CATEGORY1",
"TEST CATEGORY2"
],
"activeConfidentialCategory" : "COPAYMENTS/VETERAN BILLING"
},
"emergencyResponse" : "HURRICANE",
"emergencyContactPrimary" : {
"name" : "SMITH, MADELINE",
"relationship" : "SISTER",
"contactDetails" : {
"phone" : "987-654-1122",
"home" : "987-654-1133"
},
"address" : {
"street" : "7511 LINCOLN WAY",
"streetLine2" : "UNIT 588",
"streetLine3" : "BLDG 10",
"city" : "HERMITAGE",
"state" : "TN",
"zip" : "37076",
"county" : "DAVIDSON (037)",
"country" : "UNITED STATES"
}
},
"emergencyContactSecondary" : {
"name" : "SMITH, EARL",
"relationship" : "BROTHER",
"contactDetails" : {
"phone" : "987-654-1144",
"home" : "987-654-1155"
},
"address" : {
"street" : "7512 ONE WAY",
"streetLine2" : "UNIT 555",
"streetLine3" : "BLDG 55",
"city" : "HERMITAGE",
"state" : "TN",
"zip" : "37076",
"county" : "DAVIDSON (037)",
"country" : "UNITED STATES"
}
},
"nextOfKinPrimary" : {
"name" : "SMITH, MADELINE",
"relationship" : "SISTER",
"contactDetails" : {
"phone" : "987-654-1122",
"home" : "987-654-1133"
},
"address" : {
"street" : "7500 LINCOLN WAY",
"streetLine2" : "UNIT 508",
"streetLine3" : "BLDG #5",
"city" : "HERMITAGE",
"state" : "TN",
"zip" : "37076",
"county" : "DAVIDSON (037)",
"country" : "UNITED STATES"
}
},
"nextOfKinSecondary" : {
"name" : "DANCER, MARY",
"relationship" : "SISTER",
"contactDetails" : {
"phone" : "987-654-1122",
"home" : "987-654-1133"
},
"address" : {
"street" : "6309 SUN DRIVE",
"city" : "CHICAGO",
"state" : "ILLINOIS",
"zip" : "60632",
"county" : "DAVIDSON",
"country" : "UNITED STATES"
}
},
"languages" : [{
"languagePref" : "POLISH",
"languageDate" : "2018-08-08T08:08:09-05:00"
},
{
"languagePref" : "SPANISH",
"languageDate" : "2018-09-09T08:08:09-05:00"
}
],
"militaryService" : {
"serviceInformation" : [{
"branch" : "Marine Corps",
"component" : "Regular",
"number" : "34987",
"entryDate" : "05/1/1941",
"separationDate" : "11/4/1946",
"dischargeType" : "Honorable"
},
{
"branch" : "Marine Corps",
"component" : "Reserve",
"number" : "22449",
"entryDate" : "07/5/1950",
"separationDate" : "09/5/1955",
"dischargeType" : "Honorable"
}],
"conflictLocations" : [{
"location" : "Vietnam",
"type" : "",
"serviceIndicated" : true,
"fromDate" : "04/01/1971",
"toDate" : "05/03/1972"
},
{
"location" : "Lebanon",
"type" : "",
"serviceIndicated" : true,
"fromDate" : "05-01-1992",
"toDate" : "05-01-1993"
}],
"environmentalExposures" : [{
"typeOfExposure" : "Agent Orange Exposure",
"exposureIndicated" : true,
"exposureMethod" : "",
"registrationDate" : "01/01/1971",
"examDate" : "02/02/1971",
"screeningStatus" : ""
},
{
"typeOfExposure" : "Ionizing Radiation",
"exposureIndicated" : true,
"exposureMethod" : "",
"registrationDate" : "03/03/1971",
"examDate" : "04/04/1971",
"screeningStatus" : ""
},
{
"typeOfExposure" : "SW Asia Cond",
"exposureIndicated" : false,
"exposureMethod" : "",
"screeningStatus" : ""
},
{
"typeOfExposure" : "N/T Radium",
"exposureIndicated" : true,
"exposureMethod" : "",
"registrationDate" : "",
"examDate" : "",
"screeningStatus" : "4"
}],
"powInformation" : {
"location" : "Vietnam",
"type" : "",
"serviceIndicated" : true,
"fromDate" : "01/01/1975",
"toDate" : "05/01/1975"
},
"combatInformation" : {
"location" : "Vietnam",
"type" : "",
"serviceIndicated" : true,
"fromDate" : "01/01/1973",
"toDate" : "01/01/1974"
},
"disabilityRetirement" : "Yes",
"disabilityDischarge" : "Yes",
"dentalInjury" : "No",
"dentalExtraction" : "No",
"purpleHeartIndicator" : "Yes",
"purpleHeartStatus" : "PENDING"
},
"healthBenefits" : {
"plans" : [
"Veteran Beneficiary Plan – Caregiver (Primary Family Caregiver)",
"Medicare Plan",
"FSA"
],
"insurance" : [{
"insuranceType" : "Blue Cross Blue Shield",
"subscriberId" : "9999999",
"groupNumber" : "44325",
"holder" : "Self",
"effectiveDate" : "2017-01-01T08:08:09-05:00",
"expiryDate" : "2018-01-01T08:08:09-05:00"
},
{
"insuranceType" : "United HealthCare",
"subscriberId" : "8888888ABC",
"groupNumber" : "44555A",
"holder" : "Spouse",
"effectiveDate" : "2017-08-01T08:08:09-05:00",
"expiryDate" : "2018-08-01T08:08:09-05:00"
}]
},
"socialHistory" : {
"maritalStatus" : "Never Married",
"religion" : "Baptist",
"race" : "White",
"raceSource" : "Self Identification",
"ethnicity" : "Not Hispanic or Latino",
"ethnicitySource" : "Self Identification"
},
"clinicInformation" : {
"clinicsEnrolledIn" : [
"Cardiology",
"General Medicine",
"Radiology"
],
"futureAppointments" : [{
"clinic" : "Cardiology",
"appointmentDate" : "2019-01-10T08:00:09-05:00"
},
{
"clinic" : "General Medicine",
"appointmentDate" : "2019-02-19T10:00:09-05:00"
},
{
"clinic" : "Cardiology",
"appointmentDate" : "2019-02-05T15:30:09-05:00"
}]
},
"pharmacyInformation" : {
"cnhCurrent" : "Yes",
"feeHospitalId" : "Issued",
"capInformation" : "Non-Safety",
"mailInformation" : "Local – Regular Mail",
"mailStatusExpDate" : "2019-10-31T08:00:09-05:00",
"dialysisPatient" : "Yes",
"nursingHome" : "Yes",
"nursingHomeContract" : "Yes",
"lastDateOfContract" : "2019-08-07T08:00:09-05:00",
"respiteStartDate" : "2019-01-04T08:00:09-05:00",
"respiteEndDate" : "2019-02-10T08:00:09-05:00",
"otherLanguagePref" : "Yes",
"pmiLanguagePref" : "French",
"remarks" : "This is the remarks field and allows for up to 60 characters about the patient.",
"opNarrative" : "This is the outpatient narrative field and contains notable information about the patient that pertains to pharmacy. This field allows up to 250 characters.",
"ipNarrative" : "This is the inpatient pharmacy narrative field about the patient. This field allows up to 250 characters."
}
}