{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHERYL C JOHNSON","gend":1,"add":"1401 BARRIDALE ROAD APT B  ","city":"RICHMOND ","state":"VA","zip":"23225-9998","dob":"1953-02-04","age":"","mstatus":"","insh":11004202,"cliId":"4EV9VW3VX13","pno":8043081966,"cno":8043081966,"email":"","ename":"","eno":"","pphy":"PINSON, ANDY G ","ppno":8048288786,"pcpadd":"417 N 11th St","pcpcity":"Richmond ","pcpstate":"VA","pcpzip":232985002,"pcpcounty":"","pcpid":"P0060138","pcpname":"MCV AMBULATORY CARE CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1401 BARRIDALE ROAD APT B  ","madd2":"","madd3":"","mcity":"RICHMOND ","mstate":"VA","mzip":"23225-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","E21.3","E78.5","M06.4","D50.9","E55.9","Z79.899","Z98.890","E03.9","E89.0","E66.01","Z68.43","R76.8","Z13.9","M19.90","R71.8","Z12.31","Z23","D64.9","E66.9","Z85.3"],"date":["2020-07-24","2020-01-15","2021-02-01","2021-07-14","2020-01-15","2020-07-24","2021-02-01","2020-01-15","2020-07-24","2021-07-14","2019-11-20","2019-03-13","2020-04-21","2020-07-24","2020-07-24","2021-07-14","2019-09-13","2019-11-20","2021-07-14","2018-11-21","2018-11-21"],"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":[["","16714044802","AMITRIPTYLIN","TAB 50MG","","Select","Select",""],["","59762500002","SULFASALAZIN","TAB 500MG","","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","","Select","Select",""],["","29300024310","AMLODIPINE","TAB 10MG","","Select","Select",""],["","16714087603","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","55111023105","PRAVASTATIN","TAB 40MG","","Select","Select",""],["","378182177","LEVOTHYROXIN","TAB 300MCG","","Select","Select",""],["","16729018217","HYDROCHLOROT","TAB 12.5MG","","Select","Select",""],["","29300024310","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","16714087603","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","43547035411","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","59762500001","SULFASALAZIN ","TAB 500MG","120","Select","Select",""],["","781519092","LEVOTHYROXIN ","TAB 300MCG","30","Select","Select",""],["","16729018217","HYDROCHLOROT ","TAB 12.5MG","30","Select","Select",""],["","16714044802","AMITRIPTYLIN ","TAB 50MG","30","Select","Select",""],["","60505017007","PRAVASTATIN ","TAB 40MG","30","Select","Select",""],["","49281012165","FLUZONE","2021-22","0.7","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","49281012165","FLUZONE ","INJ 2021-22","0.7","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","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":""}]}]}