{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RENDELL M SHAW","gend":0,"add":"522 LUNENBURG AVE ","city":"VICTORIA ","state":"VA","zip":"23974-9998","dob":"1976-07-06","age":"","mstatus":"","insh":11003813,"cliId":"2WG8V83TF30","pno":4346961125,"cno":4344802258,"email":"","ename":"","eno":"","pphy":"YORK, LISA M","ppno":4346962165,"pcpadd":"200 E 5th St","pcpcity":"CHASE CITY  ","pcpstate":"VA","pcpzip":239241456,"pcpcounty":"","pcpid":"P9058797","pcpname":"LUNENBURG MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"P.O. BOX 43 ","madd2":"","madd3":"","mcity":"VICTORIA ","mstate":"VA","mzip":"23974-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["G80.9","R39.81","Z99.3","Z23","Q02","G81.10","G80.1","R11.2","J02.9","R05","J06.9","R50.9","A78","Z00.00","Z00.01","D69.49","R47.01","D69.6","Z12.5"],"date":["2021-11-17","2021-11-17","2021-11-17","2021-11-02","2021-11-02","2020-01-08","2020-04-17","2019-11-27","2020-01-04","2020-01-15","2020-01-04","2020-01-15","2020-01-15","2019-03-04","2020-04-17","2021-11-02","2020-04-17","2021-11-02","2021-11-02"],"priorHcc":[null,null,null,null,null,"","","","","","","","","","",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":[["","65862053575","AMOX\/K CLAV","SUS 600\/5ML","","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","65862053575","AMOX\/K ","SUS 600\/5ML","150","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","65862053575","AMOX\/K","600\/5ML","150","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":""}]}]}