{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WYLEANE W COOPER","gend":1,"add":"36005 BROADWATER RD  ","city":"IVOR  ","state":"VA","zip":"23866-9998","dob":"1960-08-11","age":"","mstatus":"","insh":11006997,"cliId":"2M76DE2NN46","pno":7578596628,"cno":7575829256,"email":"","ename":"","eno":"","pphy":"KODURI, PRASHANTHI","ppno":7579832200,"pcpadd":"3920 Bridge Rd Ste 207A","pcpcity":"Suffolk  ","pcpstate":"VA","pcpzip":234351107,"pcpcounty":"","pcpid":"P0140912","pcpname":"SENTARA FAMILY MEDICINE PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT. # B","add3":"","madd1":"PO BOX 48","madd2":"APT. # B","madd3":"","mcity":"IVOR  ","mstate":"VA","mzip":"23866-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I69.310","R39.81","I63.00","I10","I69.359","I71.03","H40.1131","H25.13","K80.20","N28.1","K76.89","N20.9","R59.0","R19.04","Z95.828","Z86.73","Z00.00","Z23","Z98.890","Z86.79","Z12.31","K76.9","I77.9","I71.01","R22.41","N95.0","E55.9"],"date":["2021-07-01","2021-11-01","2019-09-02","2021-07-14","2021-07-14","2020-12-08","2020-09-02","2019-07-26","2020-12-04","2019-08-30","2019-08-30","2019-08-30","2019-08-30","2019-08-30","2019-08-30","2019-10-16","2020-12-23","2019-10-16","2020-12-08","2020-12-08","2019-10-16","2021-07-07","2020-12-23","2020-12-23","2020-12-23","2021-07-14","2021-07-14"],"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":[["","93505698","ATORVASTATIN","TAB 10MG","","Select","Select",""],["","65026005","TRAVATAN Z","DRO 0.00004","","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","60505059301","TRAVOPROST","DRO 0.00004","","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","","Select","Select",""],["","68645019159","METOPROL TAR","TAB 100MG","","Select","Select",""],["","68645055454","LISINOPRIL","TAB 30MG","","Select","Select",""],["","68382039801","POT CHLORIDE","TAB 20MEQ ER","","Select","Select",""],["","66758019092","KLOR-CON M20","TAB 20MEQ ER","","Select","Select",""],["","781572001","POT CL MICRO","TAB 20MEQ ER","","Select","Select",""],["","65026005","TRAVATAN ","DRO 0.00004","5","Select","Select",""],["","68645019159","METOPROL ","TAB 100MG","180","Select","Select",""],["","93505698","ATORVASTATIN ","TAB 10MG","90","Select","Select",""],["","60505059301","TRAVOPROST ","DRO 0.00004","5","Select","Select",""],["","68382039801","POT  CHLORIDE","TAB 20MEQ ER","30","Select","Select",""],["","68645051654","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","43547040111","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","68645055254","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","66758019092","KLOR-CON ","TAB 20MEQ ER","30","Select","Select",""],["","781572001","POT  CL MICRO","20MEQ ER","30","Select","Select",""],["","00065026005","TRAVATAN","0.00004","5","Select","Select",""],["","68645019159","METOPROL","100MG","180","Select","Select",""],["","66758019092","KLOR-CON","20MEQ ER","30","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":""}]}]}