{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICKY W COBLE","gend":0,"add":"C\/O NANCY A COBLE","city":"DUBLIN                        ","state":"VA","zip":"24084-9998","dob":"1988-09-15","age":"","mstatus":"","insh":11000189,"cliId":"1V07YU8NY58","pno":5406749439,"cno":5406749439,"email":"","ename":"","eno":"","pphy":"BROCHERO, ALFONSO D","ppno":5407693964,"pcpadd":"2900 LAMB CIRCLE,","pcpcity":"CHRISTIANSBURG","pcpstate":"VA","pcpzip":240736344,"pcpcounty":"","pcpid":"P0124422","pcpname":"PULASKI HEALTH AND REHAB CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"6107 WESLEY ST","add3":"","madd1":"C\/O NANCY A COBLE","madd2":"6107 WESLEY ST","madd3":"","mcity":"DUBLIN","mstate":"VA","mzip":"24084-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R39.81","G80.9","N30.01","J30.2","K21.9","R30.0","N39.0","S80.861A","S80.862A","W57.XXXA","R79.89","R31.29","N13.30","R31.9","N28.89","M53.3","R33.9","R62.50","R93.422","R93.421","R93.41","N13.4","N18.4","D63.1","N18.9","N25.81","E55.9","M47.816","Z68.24","Z79.1","Z01.812","Z01.818","I12.9","N32.89","Q62.5","M41.9","G47.30","Z87.440","Z79.899","N18.5","Q87.3","D50.9","E21.1","R80.0","M10.9","M10.30","N28.9","N18.3","N13.0","R19.8","Z13.220","N18.1","M10.379","N13.9","N13.39","N13.8","Z46.6","M1A.3790","N31.9","Z93.59","N13.70","N31.8","N32.81","E03.9","Z43.5"],"date":["2021-10-09","2021-10-09","2018-06-06","2020-12-28","2020-10-22","2019-06-13","2021-08-12","2018-06-28","2018-06-28","2018-06-28","2020-12-28","2019-08-28","2021-05-20","2019-07-22","2019-07-22","2019-07-22","2021-09-13","2021-01-06","2019-08-09","2019-08-09","2019-08-09","2019-08-09","2021-08-18","2021-08-18","2020-08-12","2021-08-18","2021-08-18","2018-08-20","2018-08-20","2018-08-20","2020-10-17","2021-02-12","2020-10-22","2020-10-22","2020-10-22","2021-07-02","2020-10-22","2021-07-07","2020-10-22","2020-10-22","2021-01-06","2021-04-14","2021-04-14","2019-12-17","2019-10-25","2019-11-26","2021-05-20","2019-11-26","2019-11-26","2018-12-13","2019-12-17","2021-07-02","2019-12-17","2021-08-12","2021-08-12","2021-02-17","2021-07-07","2020-12-28","2021-08-12","2021-08-12","2021-07-07","2021-03-18","2021-03-18","2021-07-02","2021-07-07"],"priorHcc":[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":[["","57237001401","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","378180010","LEVOTHYROXIN","TAB 25MCG","","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","65862007601","CIPROFLOXACN","TAB 250MG","","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","","Select","Select",""],["","603497528","OXYBUTYNIN","TAB 5MG","","Select","Select",""],["","68180012101","CEPHALEXIN","CAP 250MG","","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","90","Select","Select",""],["","378180010","LEVOTHYROXIN ","TAB 25MCG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","10","Select","Select",""],["","65862007601","CIPROFLOXACN ","TAB 250MG","10","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","90","Select","Select",""],["","58160084252","BOOSTRIX ","INJ ","0.5","Select","Select",""],["","603497528","OXYBUTYNIN ","5MG","30","Select","Select",""],["","68180012101","CEPHALEXIN ","250MG","10","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","10","Select","Select",""],["","69452020720","CALCITRIOL","0.25MCG","39","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","",""],["Yes","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":""}]}]}