{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTAL V GALLIHUGH","gend":1,"add":"12272 FOX DEN LN  ","city":"ORANGE","state":"VA","zip":"22960-9998","dob":"1942-09-10","age":"","mstatus":"","insh":11000181,"cliId":"6XJ2YP8QQ90","pno":5406729466,"cno":5403603775,"email":"","ename":"","eno":"","pphy":"SAMUEL PASTERNACK PC","ppno":5406722555,"pcpadd":",","pcpcity":"Orange","pcpstate":"VA","pcpzip":229601037,"pcpcounty":"","pcpid":"P0124315","pcpname":"SAMUEL PASTERNACK PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"12272 FOX DEN LN  ","madd2":"","madd3":"","mcity":"ORANGE","mstate":"VA","mzip":"22960-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M16.6","I10","R30.0","M17.0","B37.2","M54.5","K21.9","G89.29","M16.0","R10.30","F41.9","M54.41","E87.1","R07.9","R07.89","F41.1","I44.7","Z87.891","Z79.899","Z88.5","S39.013D","S39.012D","Z00.00","E55.9","Z09","H60.8X2","Z23","B02.9","Z11.59","R73.09","R76.8"],"date":["2019-02-25","2021-08-16","2019-03-01","2021-08-16","2019-03-01","2020-03-11","2020-03-11","2020-03-11","2018-03-26","2018-03-26","2021-08-16","2019-09-25","2019-08-07","2019-07-29","2019-07-30","2019-07-29","2019-07-29","2019-07-29","2019-08-07","2019-07-29","2019-09-25","2019-09-25","2021-04-02","2019-09-04","2019-08-07","2019-09-04","2020-10-26","2021-04-02","2021-04-02","2021-04-02","2021-05-03"],"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":[["","378004001","CLORAZ DIPOT","TAB 7.5MG","","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","","Select","Select",""],["","65862020190","LOSARTAN POT","TAB 25MG","","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","","Select","Select",""],["","24208063110","NEO\/POLY\/HC","SOL 1% OTIC","","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","180","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","180","Select","Select",""],["","65862020190","LOSARTAN ","TAB 25MG","90","Select","Select",""],["","378004001","CLORAZ ","TAB 7.5MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","69097081312","GABAPENTIN ","CAP 100MG","30","Select","Select",""],["","31722070530","VALACYCLOVIR ","TAB 1GM","21","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","24208063110","NEO\/POLY\/HC ","SOL 1% OTIC","10","Select","Select",""],["","65162019050","NAPROXEN ","500MG","180","Select","Select",""],["","65862020190","LOSARTAN","25MG","90","Select","Select",""],["","00378004001","CLORAZ","7.5MG","30","Select","Select",""],["","49281012165","FLUZONE ","INJ 2021-22","0.7","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":""}]}]}