{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REBECCA L NIREN","gend":1,"add":"3100 PINETREE DRIVE  ","city":"PETERSBURG  ","state":"VA","zip":"23803-9998","dob":"1987-05-16","age":"","mstatus":"","insh":11003683,"cliId":"3GE0UA7XH08","pno":8046213117,"cno":7026133656,"email":"","ename":"","eno":"","pphy":"SARAIYA, BHAVNA A ","ppno":8047338821,"pcpadd":"50 MEDICAL PARK BLVD,STE C","pcpcity":"PETERSBURG  ","pcpstate":"VA","pcpzip":238059275,"pcpcounty":"PETERSBURG CITY","pcpid":"P0114244","pcpname":"SOUTHSIDE PRIMARY CARE PETERSBURG","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"3100 PINETREE DRIVE  ","madd2":"","madd3":"","mcity":"PETERSBURG  ","mstate":"VA","mzip":"23803-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["K21.9","L21.8","E03.9","E78.00","L98.8","E66.9","Z68.30","Z79.890","Z68.29","R68.2","N64.4","N60.42","Z01.419","Z12.4","M54.2","R23.9","H93.13","H61.22","E55.9","H05.243","R51","Z23","D18.01","J30.9","Z68.26","Z68.25","Z68.24","R87.615","N60.02","N60.01"],"date":["2019-04-08","2020-01-21","2021-07-02","2021-07-02","2019-02-01","2020-03-02","2019-02-01","2019-02-01","2020-03-02","2019-04-08","2021-10-04","2018-05-31","2021-05-25","2021-05-25","2019-10-31","2019-07-31","2018-08-01","2018-08-01","2021-07-02","2018-09-20","2019-10-31","2019-10-31","2019-12-10","2021-07-02","2021-03-19","2021-05-25","2021-07-02","2021-06-29","2021-10-04","2021-10-04"],"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":[["","781518292","LEVOTHYROXIN","TAB 75MCG","","Select","Select",""],["","68645048054","ATORVASTATIN","TAB 10MG","","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","","Select","Select",""],["","72305007530","EUTHYROX","TAB 75MCG","","Select","Select",""],["","45802046564","KETOCONAZOLE ","SHA 0.02","120","Select","Select",""],["","68645048054","ATORVASTATIN ","TAB 10MG","15","Select","Select",""],["","781518292","LEVOTHYROXIN ","TAB 75MCG","90","Select","Select",""],["","72305007530","EUTHYROX ","TAB 75MCG","90","Select","Select",""],["","60505016809","PRAVASTATIN ","10MG","30","Select","Select",""],["","60505016809","PRAVASTATIN","10MG","30","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":""}]}]}