{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALEJANDRINA ARTEAGA","gend":1,"add":"600 WINSTON CHURCHILL DRIVE","city":"HOPEWELL ","state":"VA","zip":"23860-5208","dob":"1954-03-02","age":"","mstatus":"","insh":11000392,"cliId":"1Q17R29HX68","pno":8042342231,"cno":8042342231,"email":"","ename":"","eno":"","pphy":"PASCO, HAYDEN  ","ppno":8042391640,"pcpadd":"12018 W Broad St Ste 100","pcpcity":"Richmond ","pcpstate":"VA","pcpzip":232337796,"pcpcounty":"","pcpid":"P0124051","pcpname":"PRIMARY HEALTH GROUP INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APARTMENT 2H","add3":"","madd1":"600 WINSTON CHURCHILL DRIVE","madd2":"APARTMENT 2H","madd3":"","mcity":"HOPEWELL ","mstate":"VA","mzip":"23860-5208","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R00.0","R42","R51.9","H92.09","U07.1","H92.02","F17.200","M25.50","M26.622","F33.1","F41.1","G43.909","R76.8","R63.0","R53.83","J45.909"],"date":["2021-01-21","2021-01-21","2021-01-21","2021-01-21","2021-01-21","2021-01-21","2021-01-21","2021-02-16","2021-02-16","2021-05-03","2021-06-09","2021-06-09","2021-06-09","2021-05-03","2021-05-03","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":[["","10702025350","BUT\/APAP\/CAF","TAB ","","Select","Select",""],["","65162044210","MECLIZINE","TAB 25MG","","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","228202950","ALPRAZOLAM","TAB 0.5MG","","Select","Select",""],["","65162044210","MECLIZINE ","TAB 25MG","15","Select","Select",""],["","10702025350","BUT\/APAP\/CAF ","TAB ","15","Select","Select",""],["","69097012303","TOPIRAMATE ","TAB 50MG","30","Select","Select",""],["","310737020","BUDES\/FORMOT ","AER 160-4.5","10.2","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","65862001230","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","781107705","ALPRAZOLAM ","TAB 0.5MG","60","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","69097012303","TOPIRAMATE","50MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10.2","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","",""],["Yes","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":""}]}]}