{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA B BAILEY","gend":1,"add":"9612 KATHLEEN DR  ","city":"PETERSBURG  ","state":"VA","zip":"23803-9998","dob":"1956-12-05","age":"","mstatus":"","insh":11004043,"cliId":"8DR6PJ6EJ49","pno":8045368698,"cno":8045368698,"email":"","ename":"","eno":"","pphy":"JOLANTA A HERRERA MD PLLC","ppno":8045267990,"pcpadd":"2552 Aldridge Ave","pcpcity":"South Chesterfield","pcpstate":"VA","pcpzip":238345306,"pcpcounty":"","pcpid":"P0060147","pcpname":"JOLANTA A HERRERA MD PLLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"9612 KATHLEEN DR  ","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":["G89.29","M40.204","M54.5","M65.4","M19.032","M19.042","F32.9","Z51.81","Z79.891","M50.30","M51.36","M96.1","M54.16","M25.551","R25.2","F34.1","M54.6","Z20.828","J01.00","N76.0","M47.896","M85.88","M47.816"],"date":["2021-10-14","2021-06-02","2019-10-24","2020-07-02","2020-09-03","2020-02-13","2019-10-24","2021-10-14","2021-08-19","2021-10-14","2021-10-14","2020-04-09","2020-04-09","2020-04-09","2021-01-07","2021-01-07","2020-12-10","2021-09-01","2021-09-01","2021-09-01","2021-09-15","2021-09-15","2021-09-15"],"priorHcc":[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":[["","51672413101","LAMOTRIGINE","TAB 100MG","","Select","Select",""],["","65862001330","SERTRALINE","TAB 100MG","","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","","Select","Select",""],["","42858010401","OXYCOD\/APAP","TAB 10-325MG","","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","","Select","Select",""],["","31722094301","HYDROCO\/APAP","TAB 10-325MG","","Select","Select",""],["","59746070501","CARISOPRODOL","TAB 350MG","","Select","Select",""],["","68462010340","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","68462018147","CLOTRIMAZOLE","CRE 0.01","","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","","Select","Select",""],["","378427593","VALACYCLOVIR","TAB 500MG","","Select","Select",""],["","51672413101","LAMOTRIGINE ","TAB 100MG","15","Select","Select",""],["","65862001330","SERTRALINE ","TAB 100MG","60","Select","Select",""],["","406012501","HYDROCO\/APAP ","TAB 10-325MG","90","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","240","Select","Select",""],["","42858010401","OXYCOD\/APAP ","TAB 10-325MG","120","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","59746070501","CARISOPRODOL ","TAB 350MG","120","Select","Select",""],["","68462010340","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","378427593","VALACYCLOVIR ","TAB 500MG","10","Select","Select",""],["","68462018147","CLOTRIMAZOLE ","CRE 0.01","45","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","90","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","45802013970","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","10702005601","OXYCODONE","10MG","60","Select","Select",""],["","00143924920","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","10702005601","OXYCODONE ","TAB 10MG","60","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","45802013970","METRONIDAZOL ","GEL 0.75%VAG","70","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","",""],["Yes","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":""}]}]}