{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRYSTAL V JOHNSON","gend":1,"add":"443SOUTH MAIN STREET ","city":"EMPORIA  ","state":"VA","zip":"23847-2310","dob":"1985-03-15","age":"","mstatus":"","insh":11003686,"cliId":"7K48QU5QG67","pno":9733883720,"cno":4343782273,"email":"","ename":"","eno":"","pphy":"MARCELIN, FITZGERALD ","ppno":4346347723,"pcpadd":"702 N Main St","pcpcity":"Emporia  ","pcpstate":"VA","pcpzip":238471242,"pcpcounty":"","pcpid":"P0060188","pcpname":"DINWIDDIE MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT B ","add3":"","madd1":"443SOUTH MAIN STREET ","madd2":"APT B ","madd3":"","mcity":"EMPORIA  ","mstate":"VA","mzip":"23847-2310","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F25.0","F25.1","R21","J06.9","Z23","E11.9","E78.2","Z79.4","F25.9","R45.851","R45.850","Z79.899","E78.5","Z79.84","R44.3","Z91.89","Z68.37","E66.01","F31.4","F42.2","R30.0","B37.3","Z01.419","Z11.3","Z12.39","Z12.4","E66.9","L73.9","D64.9","F41.1","R74.8","E55.9","Z28.21"],"date":["2020-02-17","2021-10-26","2019-01-18","2019-01-18","2019-01-18","2021-10-12","2021-10-12","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2021-04-13","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2021-06-30","2019-08-27","2021-11-04","2021-11-04","2018-06-04","2019-08-27","2019-08-27","2019-08-27","2019-08-27","2019-08-27","2021-06-30","2020-09-21","2020-09-21","2020-09-01","2021-06-30","2021-10-12","2021-10-12"],"priorHcc":["",null,"","","","","","","","","","","","","","","","",null,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":[["","57237001830","DULOXETINE","CAP 30MG","","Select","Select",""],["","68645057390","GLIMEPIRIDE","TAB 4MG","","Select","Select",""],["","59148001971","ABILIFY MAIN","INJ 400MG","","Select","Select",""],["","16714008210","HYDROXYZ HCL","TAB 25MG","","Select","Select",""],["","68645049554","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","13668021730","ARIPIPRAZOLE","TAB 5MG","","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","","Select","Select",""],["","555032302","HYDROXYZ PAM","CAP 25MG","","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","50924097110","SOFTCLIX","MIS LANCETS","","Select","Select",""],["","50924088401","ACCU-CHEK","TES COMPACT","","Select","Select",""],["","53885004601","ONETOUCH","KIT ULTRA 2","","Select","Select",""],["","53885001110","ONETOUCH DEL","MIS PLUS 30G","","Select","Select",""],["","59148001971","ABILIFY ","INJ 400MG","1","Select","Select",""],["","57237001830","DULOXETINE ","CAP 30MG","90","Select","Select",""],["","68645058259","METFORMIN ","TAB 500MG","120","Select","Select",""],["","16714008210","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","68645057290","GLIMEPIRIDE ","TAB 2MG","90","Select","Select",""],["","68645049554","ATORVASTATIN ","TAB 80MG","90","Select","Select",""],["","13668021730","ARIPIPRAZOLE ","TAB 5MG","30","Select","Select",""],["","50924097110","SOFTCLIX ","MIS LANCETS","100","Select","Select",""],["","68645056259","IBUPROFEN ","TAB 600MG","24","Select","Select",""],["","50924098850","ACCU-CHEK ","TES COMPACT","102","Select","Select",""],["","55111014512","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","53885099425","ONETOUCH ","TES ULTRA","25","Select","Select",""],["","59148001971","ABILIFY","400MG","1","Select","Select",""],["","16714008210","HYDROXYZ","25MG","60","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","",""],["No","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":""}]}]}