{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHELSEA GAUGHRAN","gend":1,"add":"2921 ROBIOUS CROSSING DR","city":"MIDLOTHIAN  ","state":"VA","zip":"23113-9998","dob":"1989-05-22","age":"","mstatus":"","insh":11002473,"cliId":"1F65AD4YT59","pno":8049378656,"cno":"","email":"","ename":"","eno":"","pphy":"BRENGEL, GEORGE R ","ppno":8045608838,"pcpadd":"9220 Forest Hill Ave Ste A1","pcpcity":"Richmond ","pcpstate":"VA","pcpzip":232356800,"pcpcounty":"","pcpid":"P0124384","pcpname":"THE LAURELS OF WILLOW CREEK","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2921 ROBIOUS CROSSING DR","madd2":"","madd3":"","mcity":"MIDLOTHIAN  ","mstate":"VA","mzip":"23113-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E03.9","I95.9","B34.9","Q21.0","I34.0","I34.1","Q24.9","Q93.81","R00.0","G40.119","E34.8","D50.9","J20.9","F41.9","F70","F41.1","F71","J39.2","H61.22","H92.02","G40.909","D50.0","E56.9","F31.9","F34.1","F41.0","D64.9","F33.1","G47.00","K08.9","R01.1","Z68.35","Z79.899","Z23","R56.9","B00.9","G31.84","Z88.1","Z88.2","Z00.00","D72.819","B00.1","Q20.3","F40.10","E83.51","E55.9","F32.9","K21.9","F79","Z68.24"],"date":["2021-06-16","2019-01-23","2018-01-29","2021-06-16","2020-02-11","2020-02-11","2021-02-17","2021-06-16","2021-02-17","2021-02-17","2021-02-17","2021-06-16","2018-03-05","2021-06-16","2021-10-11","2021-10-11","2020-04-28","2018-05-01","2018-05-17","2018-05-17","2021-06-16","2018-05-25","2020-12-07","2021-06-16","2021-06-16","2021-06-16","2018-06-26","2018-09-06","2018-09-06","2018-09-06","2018-09-06","2018-09-06","2018-09-06","2021-11-22","2019-11-13","2019-11-13","2020-08-06","2019-11-13","2019-11-13","2020-12-14","2021-06-16","2020-08-06","2021-06-16","2021-06-16","2019-12-11","2020-12-14","2020-08-06","2020-08-06","2020-08-06","2020-08-06"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","",""]}},{"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":[["","68382000801","LAMOTRIGINE","TAB 100MG","","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","","Select","Select",""],["","60793085501","LEVOXYL","TAB 112MCG","","Select","Select",""],["","67877024201","QUETIAPINE","TAB 25MG","","Select","Select",""],["","16729013600","CLONAZEPAM","TAB 0.5MG","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","116200116","CHLORHEX GLU","SOL 0.0012","","Select","Select",""],["","59762371809","TRIAZOLAM","TAB 0.25MG","","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","","Select","Select",""],["","65862007150","AMOXICILLIN","SUS 400\/5ML","","Select","Select",""],["","50111056003","TRAZODONE","TAB 50MG","","Select","Select",""],["","60793085501","LEVOXYL ","TAB 112MCG","90","Select","Select",""],["","68382000801","LAMOTRIGINE ","TAB 100MG","60","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","67877025001","QUETIAPINE ","TAB 100MG","60","Select","Select",""],["","31722070530","VALACYCLOVIR ","TAB 1GM","4","Select","Select",""],["","16729013600","CLONAZEPAM ","TAB 0.5MG","360","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","20","Select","Select",""],["","116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","59762371809","TRIAZOLAM ","TAB 0.25MG","2","Select","Select",""],["","50111056003","TRAZODONE ","50MG","60","Select","Select",""],["","65862007150","AMOXICILLIN ","400\/5ML","50","Select","Select",""],["","00116200116","CHLORHEX","0.0012","473","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":""}]}]}