{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDA M ALFIER","gend":1,"add":"310 E PROSPECT ST ","city":"COVINGTON","state":"VA","zip":"24426-9998","dob":"1947-01-08","age":"","mstatus":"","insh":11001351,"cliId":"2CK4CP6PY76","pno":5409629797,"cno":"","email":"","ename":"","eno":"","pphy":"MONROE, JULIE A","ppno":5404633381,"pcpadd":"55 Comfort Way,Ste 1","pcpcity":"Lexington","pcpstate":"VA","pcpzip":244503788,"pcpcounty":"","pcpid":"P0110996","pcpname":"AUGUSTA HEALTH PRIMARY CARE LEXINGTON","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"310 E PROSPECT ST ","madd2":"","madd3":"","mcity":"COVINGTON","mstate":"VA","mzip":"24426-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R03.0","Z13.6","Z00.00","Z23","F17.210","L72.11","I10","J45.909","Z20.822","L03.114","M19.90","Z09","R42","I95.1","R55","I63.81","I67.82"],"date":["2020-07-27","2021-09-03","2021-09-03","2020-07-27","2021-02-12","2021-02-15","2021-09-24","2021-02-12","2021-02-12","2021-07-09","2021-07-06","2021-02-23","2021-09-03","2021-09-03","2021-10-12","2021-10-12","2021-10-12"],"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":[["","58160082311","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","65162062750","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","65162062750","TRAMADOL ","TAB 50MG","28","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","40","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","40","Select","Select",""],["","69238110005","DOXYCYCL","100MG","14","Select","Select",""],["","65162062750","TRAMADOL","50MG","28","Select","Select",""],["","68645055154","LISINOPRIL","5MG","30","Select","Select",""],["","68645059090","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","00093505798","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","68645055154","LISINOPRIL ","TAB 5MG","30","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":""}]}]}