{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHERYL JOHNSON","gend":1,"add":"1012 W WYTHE ST","city":"PETERSBURG  ","state":"VA","zip":"23803-9998","dob":"1958-03-01","age":"","mstatus":"","insh":11001694,"cliId":"5EV2XW8XA85","pno":8048166335,"cno":8047211444,"email":"","ename":"","eno":"","pphy":"FLEENOR, ELLEN T  ","ppno":8048296600,"pcpadd":"9950 Courthouse Rd","pcpcity":"Charles City","pcpstate":"VA","pcpzip":230303434,"pcpcounty":"","pcpid":"P0060373","pcpname":"APPOMATTOX AREA HEALTH AND WELLNESS CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1012 W WYTHE ST","madd2":"","madd3":"","mcity":"PETERSBURG  ","mstate":"VA","mzip":"23803-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","Z71.89","Z71.3","E11.9","E78.2","K21.0","I69.30","Z23","Z01.30","R07.9","I11.9","I63.00","Z11.59","Z91.19","E78.5","M25.551","Z12.11","Z12.31","L60.0","L60.3","B35.3","B35.1","Z01.419","K21.00","Z11.4","J06.9","R05","R06.02","N63.10","H25.13","H18.51","H35.363","R00.2","I34.0","R94.31","N63.11","N60.01","E11.59","E11.649","Z53.21","M79.645","M79.671","Z00.00","Z01.812","Z20.822","D12.3","I69.351","Z79.82","K21.9","Z79.899","Z79.84","Z95.2","K57.30","M54.31","M54.5","Z83.3","Z86.73","Z82.49","E11.65","R73.9","R42","E66.3","I63.9","L98.9"],"date":["2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2020-04-01","2021-08-03","2020-11-10","2019-07-19","2020-12-09","2020-12-09","2020-12-09","2019-07-05","2019-07-05","2021-02-05","2018-11-02","2021-08-03","2020-12-11","2021-09-28","2019-10-22","2021-09-28","2021-09-28","2018-10-31","2021-02-01","2020-11-10","2020-11-12","2020-11-12","2020-11-12","2019-12-23","2019-11-22","2019-11-22","2019-11-22","2020-12-09","2020-12-09","2021-06-16","2019-12-23","2019-12-23","2021-09-28","2018-01-22","2018-01-22","2018-01-25","2018-01-25","2020-02-12","2021-02-01","2021-02-01","2021-02-05","2021-02-05","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-02-05","2021-02-05","2021-04-12","2021-04-12","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-06-16","2021-06-16","2021-06-16","2021-08-03"],"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":[["","378718705","METFORMIN","TAB 1000MG","","Select","Select",""],["","172572860","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","60505014201","GLIPIZIDE","TAB 10MG","","Select","Select",""],["","51672127502","CLOTRIMAZOLE","CRE 0.01","","Select","Select",""],["","65862047099","LOSARTAN\/HCT","TAB 100-25","","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","68382009501","CARVEDILOL","TAB 25MG","","Select","Select",""],["","64380080308","RANITIDINE","TAB 150MG","","Select","Select",""],["","69097012815","AMLODIPINE","TAB 10MG","","Select","Select",""],["","70377000315","SIMVASTATIN","TAB 20MG","","Select","Select",""],["","45963055650","GABAPENTIN","CAP 300MG","","Select","Select",""],["","56151014401","TRUPLUS LANC","MIS 30G","","Select","Select",""],["","50228010705","METFORMIN ","TAB 1000MG","180","Select","Select",""],["","60505014201","GLIPIZIDE ","TAB 10MG","135","Select","Select",""],["","65862047099","LOSARTAN\/HCT ","TAB 100-25","90","Select","Select",""],["","172572860","FAMOTIDINE ","TAB 20MG","180","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","51672127502","CLOTRIMAZOLE ","CRE 0.01","30","Select","Select",""],["","10572010001","PEG-3350 ","SOL ELECTROL","4,000.00","Select","Select",""],["","68382009501","CARVEDILOL ","TAB 25MG","180","Select","Select",""],["","43547040011","CYCLOBENZAPR ","TAB 10MG","180","Select","Select",""],["","64380080308","RANITIDINE ","TAB 150MG","180","Select","Select",""],["","42806005710","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","70377000315","SIMVASTATIN ","TAB 20MG","90","Select","Select",""],["","56151014401","TRUPLUS ","MIS 30G","100","Select","Select",""],["","47884017550","EASYMAX ","","50","Select","Select",""],["","6008061","JANUMET ","50-1000","60","Select","Select",""],["","45963055650","GABAPENTIN ","300MG","60","Select","Select",""],["","47884017550","EASYMAX","","50","Select","Select",""],["","00006008061","JANUMET","50-1000","60","Select","Select",""],["","56151014401","TRUPLUS","30G","100","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":""}]}]}