{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NOTISE GRAINE","gend":1,"add":"300 UNION ST APT A4  ","city":"LAWRENCEVILLE  ","state":"VA","zip":"23868-1308","dob":"1928-08-15","age":"","mstatus":"","insh":11004265,"cliId":"4KJ0A24XK24","pno":4348482859,"cno":4348482859,"email":"","ename":"","eno":"","pphy":"ANDERSON, MICHAEL S","ppno":4346346101,"pcpadd":"6 Doctors Dr","pcpcity":"Emporia  ","pcpstate":"VA","pcpzip":238471240,"pcpcounty":"","pcpid":"P0124298","pcpname":"EMPORIA MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT A4","add3":"","madd1":"300 UNION ST APT A4  ","madd2":"APT A4","madd3":"","mcity":"LAWRENCEVILLE  ","mstate":"VA","mzip":"23868-1308","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["K62.5","K64.4","K57.30","Z79.899","I10","E78.00","Z00.00","H40.013","Z96.1","R53.1","S06.5X0A","I51.7","R91.8","J90","R94.31","R47.01","Z79.82","E78.5","H40.9","W19.XXXA","S06.5X9A","R73.9","R41.0","I62.00","R40.0","G82.50","I62.03","G93.89","R26.89","I48.91","I49.1","S06.5X0S","W19.XXXS","Z74.09","S06.5X0D","R41.89","R29.6","D64.9","Z98.890","K59.00","H04.129","E86.0","R19.5","K64.9","M25.512","I47.1","R42","I49.5","Z20.822","I11.9","D72.829","I49.9","R00.0","E66.3","Z68.26","M17.0","H91.93","Z68.25","Z13.89","M54.31"],"date":["2019-01-08","2019-01-08","2020-11-19","2021-09-15","2021-09-01","2021-09-01","2021-09-01","2021-08-25","2021-08-25","2021-03-11","2018-08-03","2021-03-12","2018-08-03","2018-08-03","2018-08-11","2018-08-03","2018-08-03","2021-03-14","2021-03-14","2018-08-28","2018-08-28","2018-08-05","2018-08-13","2018-08-09","2018-08-07","2018-08-07","2018-08-27","2018-08-09","2018-08-20","2021-03-11","2021-03-12","2018-08-13","2018-08-13","2018-08-13","2018-09-04","2018-08-13","2018-08-13","2018-08-13","2018-08-27","2018-08-28","2019-09-10","2018-12-02","2018-12-02","2018-12-02","2020-12-07","2021-03-22","2021-03-11","2021-03-14","2021-03-11","2021-03-11","2021-03-11","2021-03-12","2021-03-14","2021-09-01","2021-09-01","2020-11-19","2020-11-19","2020-11-19","2021-09-01","2021-09-15"],"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":[["","61314054701","LATANOPROST","SOL 0.00005","","Select","Select",""],["","54429731","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","60505017009","PRAVASTATIN","TAB 40MG","","Select","Select",""],["","43547035410","LISINOPRIL","TAB 20MG","","Select","Select",""],["","52268001201","SUPREP BOWEL","SOL PREP KIT","","Select","Select",""],["","68462019001","NAPROXEN","TAB 500MG","","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","","Select","Select",""],["","70461012003","FLUAD QUADRI","INJ 0.5ML","","Select","Select",""],["","57237010099","METOPROL TAR","TAB 25MG","","Select","Select",""],["","61314054701","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","54429731","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","43547035410","LISINOPRIL ","TAB 20MG","60","Select","Select",""],["","60505017009","PRAVASTATIN ","TAB 40MG","90","Select","Select",""],["","68462019001","NAPROXEN ","TAB 500MG","60","Select","Select",""],["","52268001201","SUPREP ","SOL PREP KIT","354","Select","Select",""],["","59746017506","PREDNISONE ","TAB 20MG","18","Select","Select",""],["","57237010099","METOPROL ","TAB 25MG","90","Select","Select",""],["","70461012003","FLUAD ","INJ 0.5ML","0.5","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","57237010099","METOPROL","25MG","90","Select","Select",""],["","70461012003","FLUAD","0.5ML","0.5","Select","Select",""],["","49281012165","FLUZONE","2021-22","0.7","Select","Select",""],["","49281012165","FLUZONE ","INJ 2021-22","0.7","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":""}]}]}