{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELNA GOAD","gend":1,"add":"648 BUFFALO ROAD  ","city":"HILLSVILLE  ","state":"VA","zip":"24343-9998","dob":"1929-09-28","age":"","mstatus":"","insh":11004244,"cliId":"6C94TD2PK96","pno":2763982850,"cno":2763982850,"email":"","ename":"","eno":"","pphy":"TATE, GLEN E","ppno":2763982292,"pcpadd":"40 Wiley Dr","pcpcity":"Ferrum","pcpstate":"VA","pcpzip":240881100,"pcpcounty":"","pcpid":"P0114064","pcpname":"TRI AREA COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"648 BUFFALO ROAD  ","madd2":"","madd3":"","mcity":"HILLSVILLE  ","mstate":"VA","mzip":"24343-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R39.81","H60.313","E11.49","M79.10","E03.9","I10","E78.2","H61.22","N18.3","I48.91","I50.20","I21.4","R80.9","D69.6","H91.93","M15.9","G62.9","Z00.00","K59.00","I51.81","I48.19","E11.9","E66.9","H04.123","H91.13","I25.2","I42.9","K08.109","M21.941","M21.942","M47.816","N39.41","Z68.30","Z79.01","Z79.82","Z79.84","Z79.899","Z97.2","Z97.4","Z98.890","Z23","R05","R53.1","R77.8","I25.10","I15.8","I27.21","I42.8","Z88.8","Z96.651","Z98.61","J81.1","I51.7","R06.02","I08.3","N18.31","Z20.828","R11.2","R19.7","R41.82","I27.20","I50.9","R04.0","E78.5","R26.9","E55.9","R06.09","N18.30","H90.5"],"date":["2021-11-12","2020-01-22","2021-10-28","2019-11-21","2021-10-28","2021-10-28","2021-10-28","2019-02-07","2020-08-15","2021-11-12","2021-10-28","2021-10-28","2020-02-27","2020-02-27","2020-02-27","2021-10-28","2021-08-27","2021-08-27","2019-05-14","2020-08-14","2021-02-04","2021-11-12","2018-08-29","2018-08-29","2018-08-29","2018-08-29","2018-08-29","2018-08-29","2018-08-29","2018-08-29","2018-08-29","2018-08-29","2018-08-29","2021-11-08","2021-11-06","2020-12-06","2020-12-06","2018-08-29","2018-08-29","2018-08-29","2021-10-04","2018-11-05","2020-12-14","2020-12-14","2021-02-04","2020-12-06","2021-02-04","2021-08-27","2020-12-06","2020-12-06","2020-12-06","2020-12-06","2020-12-07","2020-12-06","2020-12-18","2021-10-28","2020-12-05","2020-12-05","2020-12-05","2020-12-05","2020-12-18","2021-11-12","2021-11-11","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-11-16"],"priorHcc":[null,"",null,"",null,null,null,"","",null,null,null,"","","",null,"","","","","",null,"","","","","","","","","","","",null,null,"","","","","","","","","","","","","","","","","","","","",null,"","","","","",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":[["","23155010205","METFORMIN","TAB 500MG","","Select","Select",""],["","65862020399","LOSARTAN POT","TAB 100MG","","Select","Select",""],["","193658621","MICROLET","MIS LANCETS","","Select","Select",""],["","13668010410","ISOSORB MONO","TAB 30MG ER","","Select","Select",""],["","378180777","LEVOTHYROXIN","TAB 88MCG","","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","68382009205","CARVEDILOL","TAB 3.125MG","","Select","Select",""],["","193731150","CONTOUR","TES NEXT","","Select","Select",""],["","53746051110","SPIRONOLACT","TAB 25MG","","Select","Select",""],["","51672404801","CLOTRIM\/BETA","CRE DIPROP","","Select","Select",""],["","3089421","ELIQUIS","TAB 5MG","","Select","Select",""],["","193654621","BAYER MICRLT","MIS LANCETS","","Select","Select",""],["","59762330403","NITROGLYCERN","SUB 0.4MG","","Select","Select",""],["","16714087603","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","67877019705","AMLODIPINE","TAB 2.5MG","","Select","Select",""],["","65862020399","LOSARTAN ","TAB 100MG","30","Select","Select",""],["","13668010410","ISOSORB ","TAB 30MG ER","15","Select","Select",""],["","23155010205","METFORMIN ","TAB 500MG","60","Select","Select",""],["","378180777","LEVOTHYROXIN ","TAB 88MCG","30","Select","Select",""],["","67877019705","AMLODIPINE ","TAB 2.5MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","15","Select","Select",""],["","193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","68382009205","CARVEDILOL ","TAB 3.125MG","60","Select","Select",""],["","3089321","ELIQUIS ","TAB 2.5MG","60","Select","Select",""],["","59746021605","SPIRONOLACT ","TAB 25MG","15","Select","Select",""],["","193731150","CONTOUR ","TES NEXT","50","Select","Select",""],["","193654621","BAYER ","MIS LANCETS","100","Select","Select",""],["","59762330403","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","51672404801","CLOTRIM\/BETA ","CRE DIPROP","15","Select","Select",""],["","16714087603","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","LITE","50","Select","Select",""],["","13668010410","ISOSORB","30MG ER","15","Select","Select",""],["","31722070210","LOSARTAN","100MG","30","Select","Select",""],["","00193654621","BAYER","LANCETS","100","Select","Select",""],["","99073070822","FREESTYLE TES LITE","LITE","50","Select","Select",""],["","99073013001","FREESTYLE MIS LANCETS","LANCETS","100","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","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":""}]}]}