{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EDURTREGNWORB E ","gend":1,"add":" NIATNUOM 3532 ECARRET WEIV","city":"GRANDIN ROAD","state":"VA","zip":"24015-9998","dob":"1929-11-01","age":"","mstatus":"","insh":"10119443","cliId":"9CT0H72NQ05","pno":"4304576342","cno":5403424367,"email":"","ename":"","eno":"","pphy":"LANTZ, JERI LYNN  ","ppno":5409858100,"pcpadd":"1030 S Jefferson St Ste 106","pcpcity":"Roanoke  ","pcpstate":"VA","pcpzip":240164418,"pcpcounty":"","pcpid":"P0117792","pcpname":"PARTRICK HENRY TEEN HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"APARTMENT 3 ","add3":"","madd1":"2353 MOUNTAIN VIEW TERRACE ","madd2":"APARTMENT 3 ","madd3":"","mcity":"GRANDIN ROAD","mstate":"VA","mzip":"24015-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E11.59","Z89.432","H40.1133","I10","Z51.81","M15.9","Z79.899","E11.9","B35.1","Z96.642","I73.9","Z00.00"],"date":["2021-09-22","2021-09-22","2021-10-05","2021-09-08","2021-01-21","2021-01-21","2021-09-08","2020-12-15","2021-09-22","2020-12-15","2021-09-22","2021-09-08"],"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":[["","68180072003","AMLODIPINE","TAB 5MG","","Select","Select",""],["","70069005101","DORZOL\/TIMOL","SOL 22.3-6.8","","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","955104290","IRBESARTAN","TAB 300MG","","Select","Select",""],["","62037099901","POT CL MICRO","TAB 20MEQ ER","","Select","Select",""],["","93075305","ATENOLOL","TAB 100MG","","Select","Select",""],["","55111012105","ATORVASTATIN","TAB 10MG","","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","70069005101","DORZOL\/TIMOL ","SOL 22.3-6.8","10","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","90","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","55111012105","ATORVASTATIN ","TAB 10MG","90","Select","Select",""],["","955104290","IRBESARTAN ","TAB 300MG","90","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","90","Select","Select",""],["","93075305","ATENOLOL ","TAB 100MG","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","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":""}]}]}