{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MERTINE R WALKER","gend":1,"add":"PO BOX 103  ","city":"ST STEPHENS CH ","state":"VA","zip":"23148-0103","dob":"1952-11-22","age":"","mstatus":"","insh":11002365,"cliId":"9H26TW4TG46","pno":8045726328,"cno":8045726328,"email":"","ename":"","eno":"","pphy":"ROSE, ROBERT M ","ppno":8047693096,"pcpadd":"1041 Sharon Rd Ste 205","pcpcity":"King William","pcpstate":"VA","pcpzip":230863344,"pcpcounty":"","pcpid":"P0125298","pcpname":"AYLETT MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 103  ","madd2":"","madd3":"","mcity":"ST STEPHENS CH ","mstate":"VA","mzip":"23148-0103","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["g40.001","G40.909","Z68.29","I10","E78.5","Z23","Z78.0","Z12.31","Z12.11","Z13.5","R53.83","I69.359","H61.21","Z68.27","Z68.28","Z00.00","E87.6","Z13.31","R60.0","I27.20","I51.7","R06.02","M19.039","Z01.812","Z20.822","R07.2","I63.9","R06.89","R79.89","E78.2","I36.1","I27.0"],"date":["2018-03-01","2020-11-20","2018-02-26","2021-01-04","2020-11-20","2020-11-20","2019-07-22","2020-11-20","2020-11-20","2018-02-26","2018-02-26","2020-11-20","2018-02-26","2021-01-04","2018-10-10","2020-11-20","2018-10-10","2018-10-10","2021-01-04","2021-04-14","2021-04-14","2021-04-14","2020-11-20","2021-03-21","2021-03-21","2021-03-26","2021-04-14","2021-04-14","2021-01-04","2021-01-04","2021-01-11","2021-01-11"],"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":[["","65862024608","LEVETIRACETA","TAB 500MG","","Select","Select",""],["","51293062601","PHENOBARB","TAB 32.4MG","","Select","Select",""],["","16729000517","SIMVASTATIN","TAB 20MG","","Select","Select",""],["","43547035311","LISINOPRIL","TAB 10MG","","Select","Select",""],["","65162021250","PHENYTOIN EX","CAP 100MG","","Select","Select",""],["","832532511","POT CL MICRO","TAB 20MEQ ER","","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","65862024608","LEVETIRACETA ","TAB 500MG","360","Select","Select",""],["","62037099910","POT  CL MICRO","TAB 20MEQ ER","180","Select","Select",""],["","16729000517","SIMVASTATIN ","TAB 20MG","90","Select","Select",""],["","51293062601","PHENOBARB ","TAB 32.4MG","90","Select","Select",""],["","43547035311","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","65162021250","PHENYTOIN ","CAP 100MG","360","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","90","Select","Select",""],["","43547040111","FUROSEMIDE ","20MG","90","Select","Select",""],["","65162021250","PHENYTOIN","100MG","360","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":""}]}]}