{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEVIN L SHAW","gend":0,"add":"100 S KIPPAX STREET  ","city":"HOPEWELL ","state":"VA","zip":"23860-7818","dob":"1977-05-07","age":"","mstatus":"","insh":11004840,"cliId":"3XN2MJ3UJ86","pno":8043820403,"cno":8046646717,"email":"","ename":"","eno":"","pphy":"WILLIAMS, VALENCIA J ","ppno":7572943981,"pcpadd":"8575 IVOR ROAD,PO BOX 210","pcpcity":"IVOR  ","pcpstate":"VA","pcpzip":238660001,"pcpcounty":"","pcpid":"P0125087","pcpname":"SURRY MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APARTMENT 413  ","add3":"","madd1":"100 S KIPPAX STREET  ","madd2":"APARTMENT 413  ","madd3":"","mcity":"HOPEWELL ","mstate":"VA","mzip":"23860-7818","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F41.1","E11.9","E78.5","F41.8","Z01.20","Z79.899","Z71.6","F17.200","F43.21","Z71.89","F10.10","Z23","E11.65","Z79.84","E78.2","I10","Z79.811","Z11.59","F10.21","R03.1","S02.2XXA","S00.83XA","H11.32","G89.11","S09.90XA","Y04.0XXA","S00.212A","F32.9","F41.9","S09.93XA","W50.0XXA","J34.2","Z91.19","Z79.4","R53.83","Z71.3"],"date":["2021-10-15","2021-09-09","2021-09-09","2021-09-09","2019-01-28","2021-09-09","2020-09-29","2020-09-29","2020-11-24","2020-04-27","2019-05-28","2020-09-29","2020-12-18","2019-06-20","2019-06-20","2019-06-20","2019-06-20","2020-08-31","2020-09-29","2018-11-07","2018-12-26","2018-12-14","2018-12-14","2018-12-14","2018-12-14","2018-12-14","2018-12-14","2018-12-14","2018-12-14","2018-12-14","2018-12-21","2018-12-21","2021-09-09","2020-12-18","2021-09-09","2021-09-09"],"priorHcc":[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":[["","591084510","GLIPIZIDE ER","TAB 10MG","","Select","Select",""],["","49884098401","NATEGLINIDE","TAB 60MG","","Select","Select",""],["","68462026390","ROSUVASTATIN","TAB 20MG","","Select","Select",""],["","68001033200","LISINOPRIL","TAB 2.5MG","","Select","Select",""],["","46122004378","GNP ALCOHOL","PAD SWABS","","Select","Select",""],["","597015230","JARDIANCE","TAB 10MG","","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","","Select","Select",""],["","93005401","BUSPIRONE","TAB 10MG","","Select","Select",""],["","116200116","CHLORHEX GLU","SOL 0.0012","","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","","Select","Select",""],["","42423027101","ALCOHOL PREP","PAD MED 70%","","Select","Select",""],["","53885039310","ONETOUCH US","MIS LANCETS","","Select","Select",""],["","406012405","HYDROCO\/APAP","TAB 7.5-325","","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","591084510","GLIPIZIDE ","TAB 10MG","60","Select","Select",""],["","597015230","JARDIANCE ","TAB 10MG","30","Select","Select",""],["","62756014202","METFORMIN ","TAB 500MG ER","60","Select","Select",""],["","68001033200","LISINOPRIL ","TAB 2.5MG","30","Select","Select",""],["","57237017099","ROSUVASTATIN ","TAB 20MG","30","Select","Select",""],["","49884098401","NATEGLINIDE ","TAB 60MG","90","Select","Select",""],["","93005401","BUSPIRONE ","TAB 10MG","270","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","180","Select","Select",""],["","46122004378","GNP ","PAD SWABS","100","Select","Select",""],["","53885027210","ONETOUCH ","TES VERIO","100","Select","Select",""],["","116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","42423027101","ALCOHOL ","PAD MED 70%","100","Select","Select",""],["","56151146004","TRUE ","TES GLUCOSE","50","Select","Select",""],["","65862001705","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","69097084805","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","406012405","HYDROCO\/APAP ","7.5-325","15","Select","Select",""],["","00591084510","GLIPIZIDE","10MG","60","Select","Select",""],["","56151146004","TRUE","GLUCOSE","50","Select","Select",""],["","00116200116","CHLORHEX","0.0012","473","Select","Select",""],["","46122004378","GNP","SWABS","100","Select","Select",""],["","69097084805","ESCITALOPRAM","10MG","30","Select","Select",""],["","42423027101","ALCOHOL","MED 70%","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":""}]}]}