{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAYANTIBHAI C PATEL","gend":0,"add":"11731SHALLOW COVE DRIVE ","city":"CHESTER  ","state":"VA","zip":"23836-5940","dob":"1951-12-29","age":"","mstatus":"","insh":11002856,"cliId":"2ED9D02YJ47","pno":8049380678,"cno":8046745939,"email":"","ename":"","eno":"","pphy":"BRENNAN, SIRISHA  ","ppno":8046122980,"pcpadd":"681 Hioaks Rd,Fl 2","pcpcity":"Richmond ","pcpstate":"VA","pcpzip":232254043,"pcpcounty":"","pcpid":"P0114199","pcpname":"PRIMARY HEALTH GROUP INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"11731SHALLOW COVE DRIVE ","madd2":"","madd3":"","mcity":"CHESTER  ","mstate":"VA","mzip":"23836-5940","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E11.3293","H25.12","H04.123","R05","E11.9","E66.9","E78.5","G47.00","H91.13","I10","J30.9","K21.9","M25.561","M25.562","M79.671","M79.672","Z68.35","Z79.51","Z79.84","Z79.899","R21","Z68.34","I25.10","N39.0","R09.81","Z68.36","M17.11","R51","B34.9","M54.5","J31.0","J34.2","H65.20","H65.21","H91.90"],"date":["2018-02-21","2018-02-21","2018-02-21","2018-03-29","2019-08-06","2018-04-12","2018-04-12","2018-04-12","2018-04-12","2019-08-06","2018-04-12","2019-08-06","2019-08-06","2018-04-12","2018-04-12","2018-04-12","2018-04-12","2018-04-12","2018-04-12","2018-04-12","2019-05-01","2019-05-01","2019-08-02","2019-05-31","2019-08-02","2019-08-06","2019-06-28","2019-08-02","2019-08-06","2019-08-06","2019-08-12","2019-08-12","2019-08-12","2019-08-12","2019-08-12"],"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":[["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","60505056000","OFLOXACIN","DRO 0.3% OP","","Select","Select",""],["","378180010","LEVOTHYROXIN","TAB 25MCG","","Select","Select",""],["","6008131","JANUMET XR","TAB 100-1000","","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","","Select","Select",""],["","65862020390","LOSARTAN POT","TAB 100MG","","Select","Select",""],["","93742698","MONTELUKAST","TAB 10MG","","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","51672404806","CLOTRIM\/BETA","CRE DIPROP","","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","60505056000","OFLOXACIN ","DRO 0.3% OP","5","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","48","Select","Select",""],["","378180010","LEVOTHYROXIN ","TAB 25MCG","30","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","6008131","JANUMET ","TAB 100-1000","90","Select","Select",""],["","93742698","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","65862020390","LOSARTAN ","TAB 100MG","90","Select","Select",""],["","49884093547","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","90","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","50111043301","TRAZODONE ","50MG","30","Select","Select",""],["","51672404806","CLOTRIM\/BETA ","DIPROP","45","Select","Select",""],["","00006008131","JANUMET","100-1000","90","Select","Select",""],["","65862020390","LOSARTAN","100MG","90","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":""}]}]}