{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NELDA S DARNELL","gend":1,"add":"2223 TAYLOR TOWN RD  ","city":"FORT BLACKMORE ","state":"VA","zip":"24250-9998","dob":"1949-10-12","age":"","mstatus":"","insh":11006926,"cliId":"6WE2EU8RN11","pno":2769402294,"cno":2769402294,"email":"","ename":"","eno":"","pphy":"CASSEL, TODD A ","ppno":2764672201,"pcpadd":"17285 Veterans Memorial Hwy","pcpcity":"Dungannon","pcpstate":"VA","pcpzip":242453937,"pcpcounty":"","pcpid":"P0124083","pcpname":"CLINCH RIVER HEALTH SERVICES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2223 TAYLOR TOWN RD  ","madd2":"","madd3":"","mcity":"FORT BLACKMORE ","mstate":"VA","mzip":"24250-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","E78.5","F41.1","J30.2","Z12.39","Z79.891","Z12.31","F41.9","I48.92","E04.9","I51.9","Z13.1","Z79.899","Z91.89","Z23","R94.30","R73.9","F33.1","R63.0","R05","Z91.14","Z86.79","J30.9","R73.03","Z12.11"],"date":["2021-08-19","2021-05-19","2021-08-19","2021-05-19","2020-03-11","2021-02-17","2021-06-22","2020-06-18","2020-06-18","2019-12-04","2020-06-18","2019-08-06","2021-05-19","2019-08-06","2021-04-07","2019-08-06","2020-11-23","2021-02-17","2020-11-16","2019-12-04","2019-12-04","2019-12-04","2021-08-19","2021-08-19","2021-05-19"],"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":[["","16729000417","SIMVASTATIN","TAB 10MG","","Select","Select",""],["","68382009810","PAROXETINE","TAB 20MG","","Select","Select",""],["","591024005","LORAZEPAM","TAB 0.5MG","","Select","Select",""],["","62037083001","METOPROL SUC","TAB 25MG ER","","Select","Select",""],["","3089321","ELIQUIS","TAB 2.5MG","","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","","Select","Select",""],["","45963067611","METOPROLOL","TAB 50MG ER","","Select","Select",""],["","49281012065","FLUZONE HD","INJ PF 20-21","","Select","Select",""],["","591024005","LORAZEPAM ","TAB 0.5MG","60","Select","Select",""],["","68382009810","PAROXETINE ","TAB 20MG","90","Select","Select",""],["","16729000417","SIMVASTATIN ","TAB 10MG","49","Select","Select",""],["","68382056501","METOPROL ","TAB 50MG ER","90","Select","Select",""],["","3089321","ELIQUIS ","TAB 2.5MG","180","Select","Select",""],["","31722072690","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","45963067611","METOPROLOL ","TAB 50MG ER","45","Select","Select",""],["","49281012065","FLUZONE ","INJ PF 20-21","0.7","Select","Select",""],["","68382056501","METOPROL","50MG ER","90","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","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","",""],["Yes","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":""}]}]}