{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" L KNARFEFFILLOJ","gend":0,"add":"LOJ 23101 NL EFFIL","city":"RIXEYVILLE  ","state":"VA","zip":"22737-9998","dob":"1966-01-10","age":"","mstatus":"","insh":"10117342","cliId":"9U34KT4QU77","pno":"1304535557","cno":5403175553,"email":"","ename":"","eno":"","pphy":"SEALANDER, JOHN Y ","ppno":5409486871,"pcpadd":"120 N Commerce Ave,Ste 102","pcpcity":"Front Royal ","pcpstate":"VA","pcpzip":226302671,"pcpcounty":"","pcpid":"P0133970","pcpname":"RIDGELINE PHYSICIAN SERVICES PLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"10132 JOLLIFFE LN ","madd2":"","madd3":"","mcity":"RIXEYVILLE  ","mstate":"VA","mzip":"22737-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R05","J11.1","J02.9","F25.1","E78.2","I10","F41.9","E55.9","Z11.59","Z79.899","Z09","R60.0","Z00.00","M79.89","R63.1","E61.2","Z23","R79.0","F33.0"],"date":["2020-03-03","2020-03-03","2020-03-03","2021-04-29","2021-10-25","2021-10-25","2020-06-24","2021-10-25","2021-07-23","2021-05-10","2020-06-24","2020-09-29","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-09-01","2021-10-25","2021-10-25"],"priorHcc":["","","","",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":[["","13668013701","ESCITALOPRAM","TAB 20MG","","Select","Select",""],["","62756079888","DIVALPROEX","TAB 500MG DR","","Select","Select",""],["","69097082707","BENZTROPINE","TAB 1MG","","Select","Select",""],["","43547034306","RISPERIDONE","TAB 3MG","","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","49281072010","FLUBLOK QUAD","INJ 2020-21","","Select","Select",""],["","70377000712","ROSUVASTATIN","TAB 10MG","","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","","Select","Select",""],["","13668013701","ESCITALOPRAM ","TAB 20MG","90","Select","Select",""],["","69097082707","BENZTROPINE ","TAB 1MG","180","Select","Select",""],["","62756079888","DIVALPROEX ","TAB 500MG DR","270","Select","Select",""],["","43547034306","RISPERIDONE ","TAB 3MG","90","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","49281072010","FLUBLOK ","INJ 2020-21","0.5","Select","Select",""],["","70377000712","ROSUVASTATIN ","TAB 10MG","90","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","90","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0.5","Select","Select",""],["","00378020810","FUROSEMIDE","20MG","90","Select","Select",""],["","43547040111","FUROSEMIDE ","TAB 20MG","90","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","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}