{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DARYL KNIGHT","gend":0,"add":"1208 EASTERLY AVE ","city":"HAMPTON  ","state":"VA","zip":"23669-9998","dob":"1981-06-26","age":"","mstatus":"","insh":11002606,"cliId":"3G89JP0YR39","pno":7572651407,"cno":7572651407,"email":"","ename":"","eno":"","pphy":"BOYER, DEBRA","ppno":7578501311,"pcpadd":"191 Fox Hill Rd Ste D","pcpcity":"Hampton  ","pcpstate":"VA","pcpzip":236692360,"pcpcounty":"","pcpid":"P9058604","pcpname":"ELIZABETH LAKES FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1208 EASTERLY AVE ","madd2":"","madd3":"","mcity":"HAMPTON  ","mstate":"VA","mzip":"23669-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R03.0","F17.210","Z68.23","E55.9","J45.909","L30.9","E78.1","B35.3","L98.8","R20.8","M79.675","F17.200","M79.672","L03.032","M54.2"],"date":["2018-05-09","2018-05-09","2018-05-09","2018-06-20","2018-06-20","2018-06-20","2018-06-20","2020-10-15","2020-10-15","2020-10-15","2020-10-15","2020-10-15","2020-10-15","2021-01-30","2021-09-23"],"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":[["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","93101042","MUPIROCIN","OIN 0.02","","Select","Select",""],["","93314705","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","93314705","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","93101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","70010075401","METHOCARBAM","500MG","40","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","40","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":""}]}]}