{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEROY SCHAFFER","gend":0,"add":"713 MERRIMAN WAY RD.","city":"MONETA","state":"VA","zip":"24523-1213","dob":"1956-10-25","age":"","mstatus":"","insh":11000535,"cliId":"1U19TU3HK10","pno":5404837974,"cno":5408140434,"email":"","ename":"","eno":"","pphy":"COX, BRANDON K","ppno":5402977181,"pcpadd":"1613 Oakwood St","pcpcity":"Bedford","pcpstate":"VA","pcpzip":245231213,"pcpcounty":"","pcpid":"P9059188","pcpname":"VILLAGE FAMILY PHYSICIANS INC","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICARE","lob":"DSNP","region":"ROANOKE\/ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"713 MERRIMAN WAY RD.","madd2":"","madd3":"","mcity":"MONETA","mstate":"VA","mzip":"24121-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F29","F33.1","E11.9","E78.2","F39","G80.3","H47.293","H40.10X3","M79.601","M25.561","F20.9","E11.42","E66.9","E78.5","F41.9","F79","K21.9","M25.539","M62.838","R26.9","Z72.0","Z79.84","Z80.9","Z83.3","Z91.81","Z12.5","E55.9","Z13.29","F70","R68.89","M99.03","M99.01","M62.831","M99.08","M54.31","F41.1","Z12.11","M99.05","A17.0","A15.0","B35.1","F17.210","J44.0","J20.9","H90.5","M46.96","G89.29","M54.5","M54.40","M54.41","Z86.61","S80.861A","W57.XXXA","M21.171","R25.2","D50.8","M15.0","G47.62","Z23","H40.1133","F33.0","F48.9","Z00.8","F32.9","G31.84","I10","Z85.828","Z79.899","I45.10","R94.31","Z04.6"],"date":["2021-03-12","2021-06-25","2021-04-27","2021-02-11","2021-02-11","2021-05-07","2020-07-09","2019-10-17","2021-05-07","2019-02-05","2019-09-12","2019-09-12","2019-09-12","2021-04-27","2021-04-27","2019-09-12","2021-02-11","2019-09-12","2019-09-12","2019-09-12","2019-09-12","2021-04-27","2019-09-12","2019-09-12","2019-09-12","2020-10-26","2020-10-26","2020-10-26","2017-12-22","2017-12-28","2017-12-04","2017-12-04","2017-11-16","2017-11-16","2017-11-16","2021-04-11","2017-11-28","2017-12-04","2020-01-07","2021-05-07","2020-03-10","2021-04-27","2019-12-26","2019-12-26","2019-05-03","2019-05-06","2019-05-06","2019-06-24","2019-05-06","2019-06-06","2019-05-28","2019-05-31","2019-05-31","2019-06-24","2019-06-24","2019-12-26","2019-12-26","2019-12-26","2019-12-26","2021-01-07","2021-07-02","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27"],"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":[["","65702028810","FASTCLIX","MIS LANCETS","","Select","Select",""],["","70010049105","METFORMIN HCL","ER ORAL TAB","","Select","Select",""],["","16714070701","MIRTAZAPINE","TAB 15MG","","Select","Select",""],["","65026025","TRAVATAN Z","DRO 0.00004","","Select","Select",""],["","2143380","TRULICITY","INJ 0.75\/0.5","","Select","Select",""],["","69367020305","BUT\/APAP\/CAF","TAB ","","Select","Select",""],["","16714087603","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","43547026910","ROPINIROLE","TAB 0.5MG","","Select","Select",""],["","16714033202","GABAPENTIN","TAB 800MG","","Select","Select",""],["","591024010","LORAZEPAM","TAB 0.5MG","","Select","Select",""],["","16714071503","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","","Select","Select",""],["","57599000200","FREESTYLE","MIS READER","","Select","Select",""],["","69097083305","SERTRALINE","TAB 25MG","","Select","Select",""],["","16714045201","QUETIAPINE","TAB 25MG","","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","","Select","Select",""],["","16714007106","BACLOFEN","TAB 10MG","","Select","Select",""],["","487950125","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","65702071110","ACCU-CHEK","TES GUIDE","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","8290326895","BD SWAB REG","PAD SNGL USE","","Select","Select",""],["","8222440006","ULTICARE","PAD ALCOHOL","","Select","Select",""],["","49348089610","SM ALCOHOL","PAD PREP","","Select","Select",""],["","65862037505","ESCITALOPRAM","TAB 20MG","","Select","Select",""],["","58160084211","BOOSTRIX","INJ ","","Select","Select",""],["","24208046325","LATANOPROST","SOL 0.00005","","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","10370010150","BUPROPN HCL","TAB 150MG XL","","Select","Select",""],["","65702073110","ACCU-CHECK","KIT GUIDE ME","","Select","Select",""],["","781185220","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","50428034618","ALCOHOL PREP","PAD 0.7","","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","","Select","Select",""],["","591024110","LORAZEPAM ","TAB 1MG","90","Select","Select",""],["","2143380","TRULICITY ","INJ 0.75\/0.5","2","Select","Select",""],["","65702071110","ACCU-CHEK ","TES GUIDE","50","Select","Select",""],["","16714074703","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","16714087603","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","16714045201","QUETIAPINE ","TAB 25MG","60","Select","Select",""],["","43547026910","ROPINIROLE ","TAB 0.5MG","90","Select","Select",""],["","65702028810","FASTCLIX ","MIS LANCETS","102","Select","Select",""],["","16714007106","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","16714033202","GABAPENTIN ","TAB 800MG","90","Select","Select",""],["","70010049105","METFORMIN ","ER ORAL TAB","30","Select","Select",""],["","76282066339","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","16714070701","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","16714061205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","65026025","TRAVATAN ","DRO 0.00004","2.5","Select","Select",""],["","10702025301","BUT\/APAP\/CAF ","TAB ","30","Select","Select",""],["","59762033302","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","487950125","ALBUTEROL ","NEB 0.00083","75","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","8222440006","ULTICARE ","PAD ALCOHOL","100","Select","Select",""],["","8290326895","BD ","PAD SNGL USE","100","Select","Select",""],["","49348089610","SM ","PAD PREP","100","Select","Select",""],["","781185220","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","65862037505","ESCITALOPRAM ","TAB 20MG","30","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","1","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","50428034618","ALCOHOL ","PAD 0.7","100","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","65702073110","ACCU-CHECK ","KIT GUIDE ME","1","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","58160084211","BOOSTRIX ","INJ ","0.5","Select","Select",""],["","99073070914","FREESTYLE    KIT FREEDOM","KIT FREEDOM","1","Select","Select",""],["","10370010150","BUPROPN ","150MG XL","30","Select","Select",""],["","45802006435","TRIAMCINOLON ","0.10%","15","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","",""],["Yes","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":""}]}]}