{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KASHIF CARTER","gend":0,"add":"4446 ALLEN RD  ","city":"JARRATT  ","state":"VA","zip":"23867-9998","dob":"1987-07-07","age":"","mstatus":"","insh":11000369,"cliId":"6PJ0JE3RE00","pno":9732207369,"cno":4343780839,"email":"","ename":"","eno":"","pphy":"ANDERSON, MICHAEL S","ppno":4346346101,"pcpadd":"6 Doctors Dr","pcpcity":"Emporia  ","pcpstate":"VA","pcpzip":238471240,"pcpcounty":"","pcpid":"P0124298","pcpname":"EMPORIA MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"4446 ALLEN RD  ","madd2":"","madd3":"","mcity":"JARRATT  ","mstate":"VA","mzip":"23867-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["G80.4","R39.81","G80.9","Z99.3","G40.909","G40.411","F41.1","F91.8","Z79.899","F79","M25.551","Z00.01","I10","F73","F39","L20.9","L60.3","L60.1","M79.674","M79.675","F41.9","R53.83","B35.1","L22","R45.1","Z23"],"date":["2021-06-22","2021-11-11","2021-11-23","2021-11-11","2021-11-23","2021-03-24","2019-08-28","2020-01-06","2021-11-23","2021-01-29","2020-01-06","2020-01-06","2020-02-01","2021-08-04","2021-02-09","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-17","2021-08-17","2021-08-10","2021-11-11","2021-11-23","2021-11-23"],"priorHcc":["",null,null,null,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":[["","51991065116","LEVETIRACETA","SOL 100MG\/ML","","Select","Select",""],["","555009896","CLONAZEP ODT","TAB 2MG","","Select","Select",""],["","50458059601","RISPERIDONE","SOL 1MG\/ML","","Select","Select",""],["","555009896","CLONAZEP ","TAB 2MG","120","Select","Select",""],["","51991065116","LEVETIRACETA ","SOL 100MG\/ML","300","Select","Select",""],["","50458059601","RISPERIDONE ","SOL 1MG\/ML","30","Select","Select",""],["","67877032001","IBUPROFEN ","600MG","30","Select","Select",""],["","16729013600","CLONAZEPAM ","0.5MG","90","Select","Select",""],["","00555009896","CLONAZEP","2MG","120","Select","Select",""],["","67877032001","IBUPROFEN","600MG","30","Select","Select",""],["","16729013600","CLONAZEPAM","0.5MG","90","Select","Select",""],["","45802006336","TRIAMCINOLON","0.03%","80","Select","Select",""],["","45802006336","TRIAMCINOLON ","CRE 0.00025","80","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":""}]}]}