{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANIELLE K ALLEN","gend":1,"add":"3601 MILLERS GLEN LN","city":"HENRICO","state":"VA","zip":"23219-1410","dob":"1980-10-10","age":"","mstatus":"","insh":11004519,"cliId":"5JN3K45RX07","pno":8042008113,"cno":8042633222,"email":"","ename":"","eno":"","pphy":"DICKERSON, TASHA B","ppno":8042257177,"pcpadd":"304 E LEIGH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":232191410,"pcpcounty":"RICHMOND CITY","pcpid":"P0060207","pcpname":"DOMINION MEDICAL ASSOCIATES","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT 208","add3":"","madd1":"5319 Blueridge Ave","madd2":"","madd3":"","mcity":"Richmond","mstate":"VA","mzip":"23231-3705","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["S83.92XA","G44.209","R51","S02.5XXA","E03.9","J45.909","Z86.59","F17.210","Z79.899","Z79.51","K08.89","X58.XXXA","Z30.46","J06.9","Z72.0","R05","Z03.818","Z11.59","G43.001","F43.9","R07.89","R07.9","R51.9","M79.89","R60.0","M54.2","F17.200","R00.2"],"date":["2020-02-20","2021-06-28","2020-05-07","2020-05-07","2021-06-28","2021-06-28","2020-05-07","2021-01-04","2021-06-28","2021-06-28","2020-05-07","2020-05-07","2018-09-10","2019-11-12","2019-11-12","2019-11-12","2020-11-30","2020-11-30","2021-01-04","2021-01-04","2021-01-04","2021-01-04","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28"],"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":[["","11534018701","BUT\/APAP\/CAF","CAP ","","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","55111029236","SUMATRIPTAN","TAB 50MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","378699252","ALBUTEROL","NEB 1.25MG\/3","","Select","Select",""],["","591544310","PREDNISONE","TAB 20MG","","Select","Select",""],["","16571020106","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","28","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","20","Select","Select",""],["","11534018701","BUT\/APAP\/CAF ","CAP ","8","Select","Select",""],["","55111029236","SUMATRIPTAN ","TAB 50MG","6","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","591544310","PREDNISONE ","20MG","15","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":""}]}]}