{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL P FRAZIER","gend":0,"add":"381 WALNUT RD","city":"PEMBROKE","state":"VA","zip":"24136-9998","dob":"1981-01-17","age":"","mstatus":"","insh":11002080,"cliId":"5VW1XH4FG91","pno":5406265652,"cno":"","email":"","ename":"","eno":"","pphy":"BOERTH, SCOTT R","ppno":5408088913,"pcpadd":"3698 S Main St, ","pcpcity":"Blacksburg","pcpstate":"VA","pcpzip":240607015,"pcpcounty":"","pcpid":"P9307339","pcpname":"FAMILY MEDICINE OF BLACKSBURG LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE\/ ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"381 WALNUT RD","madd2":"","madd3":"","mcity":"PEMBROKE","mstate":"VA","mzip":"24136-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R73.03","F90.0","Z23","Z68.41","G47.33","I10","F81.9","H53.001","K04.7"],"date":["2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-06-04","2021-05-21"],"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":[["","66993059702","AMPHET\/DEXTR","CAP 20MG ER","","Select","Select",""],["","45963067711","METOPROL SUC","TAB 100MG ER","","Select","Select",""],["","33332032001","AFLURIA QUAD","INJ 2020-21","","Select","Select",""],["","49281041950","FLUZONE QUAD","INJ 2019-20","","Select","Select",""],["","66993059702","AMPHET\/DEXTR ","CAP 20MG ER","90","Select","Select",""],["","49281041950","FLUZONE ","INJ 2019-20","0.5","Select","Select",""],["","45963067711","METOPROL ","TAB 100MG ER","90","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","21","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","21","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0.5","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":""}]}]}