{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT M HOWARD JR","gend":0,"add":"282 SHILOH AVE ","city":"WAYNESBORO  ","state":"VA","zip":"22980-9998","dob":"1971-11-18","age":"","mstatus":"","insh":11006293,"cliId":"1WN3JQ9VV95","pno":5408360977,"cno":5408360977,"email":"","ename":"","eno":"","pphy":"TAYLOR, ROBERT P  ","ppno":5409498241,"pcpadd":"25 NORTHRIDGE LANE","pcpcity":"LEXINGTON","pcpstate":"VA","pcpzip":244503399,"pcpcounty":"","pcpid":"P0125394","pcpname":"CFM ASSOCIATED PHYSICIANS WAYNESBORO","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"282 SHILOH AVE ","madd2":"","madd3":"","mcity":"WAYNESBORO  ","mstate":"VA","mzip":"22980-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E11.65","I10","E78.2","N18.3","E66.01","Z87.891","Z68.43","Z79.899","F20.9","E87.6","R73.01","R60.9","R79.89","N18.31","Z12.5","Z80.42","R00.0","Z23","D72.829","Z86.59","E11.9","D72.828"],"date":["2021-05-03","2021-05-03","2021-05-03","2020-08-06","2021-05-03","2021-05-03","2020-05-13","2020-02-11","2021-10-13","2020-06-26","2019-10-01","2019-08-02","2020-08-06","2021-05-03","2020-10-26","2020-10-26","2020-10-30","2020-10-30","2021-03-01","2021-05-03","2021-04-19","2021-05-03"],"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":[["","52817018210","CLONIDINE","TAB 0.3MG","","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","527139601","LOXAPINE","CAP 25MG","","Select","Select",""],["","53489014401","SPIRONO\/HCTZ","TAB 25\/25","","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","","Select","Select",""],["","31722070110","LOSARTAN POT","TAB 50MG","","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","","Select","Select",""],["","62037099901","POT CL MICRO","TAB 20MEQ ER","","Select","Select",""],["","68180052002","LISINOP\/HCTZ","TAB 20-25MG","","Select","Select",""],["","58657060501","LABETALOL","TAB 100MG","","Select","Select",""],["","245531911","KLOR-CON M20","TAB 20MEQ ER","","Select","Select",""],["","64980028001","GLIPIZIDE ER","TAB 5MG","","Select","Select",""],["","68180033707","METFORMIN ER","TAB 1000MG","","Select","Select",""],["","378606001","DILTIAZEM","CAP 60MG ER","","Select","Select",""],["","52817018210","CLONIDINE ","TAB 0.3MG","180","Select","Select",""],["","591037101","LOXAPINE ","CAP 25MG","5","Select","Select",""],["","62756014202","METFORMIN ","TAB 500MG ER","20","Select","Select",""],["","16729018317","HYDROCHLOROT ","TAB 25MG","180","Select","Select",""],["","65862020290","LOSARTAN ","TAB 50MG","90","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","53489014401","SPIRONO\/HCTZ ","TAB 25\/25","30","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","378606001","DILTIAZEM ","CAP 60MG ER","60","Select","Select",""],["","68180052002","LISINOP\/HCTZ ","TAB 20-25MG","60","Select","Select",""],["","58657060501","LABETALOL ","TAB 100MG","30","Select","Select",""],["","245531911","KLOR-CON ","TAB 20MEQ ER","180","Select","Select",""],["","64980028001","GLIPIZIDE ","TAB 5MG","90","Select","Select",""],["","65862020290","LOSARTAN","50MG","90","Select","Select",""],["","00245531911","KLOR-CON","20MEQ ER","180","Select","Select",""],["","64980028001","GLIPIZIDE","5MG","90","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":""}]}]}