{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES M JOHNSON","gend":0,"add":"205 INDEPENDENCE DRIVE  ","city":"FOREST","state":"VA","zip":"24551-9998","dob":"1965-11-02","age":"","mstatus":"","insh":11004241,"cliId":"3QF6DN2UT76","pno":4349423906,"cno":4349423906,"email":"","ename":"","eno":"","pphy":"JONES, WILLIAM G  ","ppno":4343762325,"pcpadd":"104 Carolina Ave","pcpcity":"Brookneal","pcpstate":"VA","pcpzip":245282643,"pcpcounty":"","pcpid":"P9443013","pcpname":"CENTRA HEALTH BROOKNEAL FAMILY MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"205 INDEPENDENCE DRIVE  ","madd2":"","madd3":"","mcity":"FOREST","mstate":"VA","mzip":"24551-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F32.2","F41.1","F42.9","Z72.0","B35.1","L60.3","E11.42","E78.00","E11.9","Z00.00","D22.5","D22.72","D22.71","D22.62","Z08","Z85.828","N50.3","N50.89","E11.3293","H25.13","I10","Z23","K44.9","K42.9","R10.31","Z90.49","K57.92","A09","D72.829","R19.7","F32.9","Z87.891","F31.9","Z20.822"],"date":["2020-12-01","2020-12-01","2020-12-01","2020-04-21","2021-08-09","2021-08-09","2021-08-09","2021-05-25","2021-05-25","2020-05-18","2019-03-27","2019-03-27","2019-03-27","2019-03-27","2019-03-27","2019-03-27","2019-03-28","2019-03-28","2020-10-13","2020-10-13","2020-05-18","2018-11-05","2019-12-29","2019-12-29","2019-12-29","2019-12-29","2019-12-29","2019-12-29","2019-12-29","2019-12-29","2019-12-29","2019-12-29","2021-08-10","2021-10-15"],"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":[["","93738201","VENLAFAXINE","TAB 75MG","","Select","Select",""],["","16729000617","SIMVASTATIN","TAB 40MG","","Select","Select",""],["","68382018205","BUSPIRONE","TAB 15MG","","Select","Select",""],["","64380079506","CYPROHEPTAD","TAB 4MG","","Select","Select",""],["","8290320122","BD PEN NEEDL","MIS 32GX4MM","","Select","Select",""],["","27241000250","RISPERIDONE","TAB 0.25MG","","Select","Select",""],["","58160082311","SHINGRIX","INJ 50MCG","","Select","Select",""],["","56151146004","TRUE METRIX","TES GLUCOSE","","Select","Select",""],["","68382031910","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","70461041910","FLUCLVX QUAD","INJ 2019-20","","Select","Select",""],["","193658621","MICROLET","MIS LANCETS","","Select","Select",""],["","99073071026","FREESTYLE","TES LITE","","Select","Select",""],["","29300022705","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","169633910","NOVOLOG","INJ FLEXPEN","","Select","Select",""],["","169266015","TRESIBA FLEX","INJ 100UNIT","","Select","Select",""],["","90166043154","PEN NEEDLES","MIS 32GX4MM","","Select","Select",""],["","42571016201","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","193654621","BAYER MICRLT","MIS LANCETS","","Select","Select",""],["","16571041210","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","64380079506","CYPROHEPTAD ","TAB 4MG","56","Select","Select",""],["","57237017501","VENLAFAXINE ","TAB 75MG","84","Select","Select",""],["","16729000617","SIMVASTATIN ","TAB 40MG","28","Select","Select",""],["","68382018205","BUSPIRONE ","TAB 15MG","84","Select","Select",""],["","56151146304","TRUE ","TES GLUCOSE","100","Select","Select",""],["","8290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","68382031910","TRAMADOL ","TAB 50MG","84","Select","Select",""],["","27241000250","RISPERIDONE ","TAB 0.25MG","84","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50MCG","1","Select","Select",""],["","169266015","TRESIBA ","INJ 100UNIT","15","Select","Select",""],["","99073071026","FREESTYLE    TES LITE","TES LITE","150","Select","Select",""],["","90166043154","PEN  NEEDLES  ","MIS 32GX4MM","200","Select","Select",""],["","70461041910","FLUCLVX ","INJ 2019-20","0.5","Select","Select",""],["","169633910","NOVOLOG ","INJ FLEXPEN","15","Select","Select",""],["","193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","29300022705","METRONIDAZOL ","TAB 500MG","21","Select","Select",""],["","16571041210","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","42571016201","AMOX\/K ","875-125","20","Select","Select",""],["","56151146304","TRUE","GLUCOSE","100","Select","Select",""],["","68382031910","TRAMADOL","50MG","84","Select","Select",""],["","99073071026","FREESTYLE TES LITE","LITE","150","Select","Select",""],["","00169266015","TRESIBA","100UNIT","15","Select","Select",""],["","70461041910","FLUCLVX","2019-20","0.5","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","42571016201","AMOX\/K","875-125","20","Select","Select",""],["","00193654621","BAYER","LANCETS","100","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","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":""}]}]}