{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"B YMAREWO","gend":1,"add":" HPESOJ 235YWH NITRAM","city":"MARTINSVILLE                  ","state":"VA","zip":"24112-9998","dob":"1983-12-27","age":"","mstatus":"","insh":"10117565","cliId":"8CD1PG8WC32","pno":"3367298026","cno":2763362089,"email":"","ename":"","eno":"","pphy":"WATERS, MICHAEL G                                           ","ppno":4346562224,"pcpadd":"305 N Main St,","pcpcity":"Gretna                        ","pcpstate":"VA","pcpzip":245574176,"pcpcounty":"","pcpid":"P0110944","pcpname":"BASSETT FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"532 JOSEPH MARTIN HWY","madd2":"","madd3":"","mcity":"MARTINSVILLE                  ","mstate":"VA","mzip":"24112-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["L89.90","L72.3","M79.671","R39.81","M62.81","N31.9","N39.490","R32","R07.1","R07.9","F32.9","E55.9","E03.9","Z20.828","M79.605","M79.662","F17.210","Z79.899","M25.562","Z98.890","N31.8","Z87.440","G50.1","R22.0","L03.211","R11.0","R42","R47.1","L97.519","L97.529","Z71.89","Z71.3","F41.9","Z87.828","K59.2","N81.6","N81.10","M26.609"],"date":["2020-12-09","2021-01-13","2021-01-13","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-05","2020-10-12","2020-10-12","2020-10-12","2021-07-13","2021-07-13","2020-10-12","2021-05-02","2021-05-03","2021-05-02","2021-07-13","2021-05-03","2021-07-13","2021-06-30","2021-06-30","2021-07-13","2021-07-16","2021-07-13","2021-07-13","2021-07-13","2021-07-15","2021-08-12","2021-08-12","2021-07-16","2021-07-16","2021-07-16","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-16"],"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":{"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":[["","23155022701","ACYCLOVIR","TAB 400MG","","Select","Select",""],["","378181377","LEVOTHYROXIN","TAB 125MCG","","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","378064205","PREDNISONE","TAB 20MG","","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","","Select","Select",""],["","23155022701","ACYCLOVIR ","TAB 400MG","25","Select","Select",""],["","378182377","LEVOTHYROXIN ","TAB 137MCG","90","Select","Select",""],["","93031401","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","378064205","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","50111064801","FLUOXETINE ","CAP 20MG","90","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","42806008301","BUSPIRONE ","7.5MG","180","Select","Select",""],["","65162019050","NAPROXEN ","500MG","30","Select","Select",""],["","00093031401","KETOROLAC","10MG","20","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","65162019050","NAPROXEN","500MG","30","Select","Select",""],["","42806008301","BUSPIRONE","7.5MG","60","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","30","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","",""],["No","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":""}]}]}