{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAL M GREENE","gend":0,"add":"557 BELLVIEW AVENUE  ","city":"WINCHESTER  ","state":"VA","zip":"22601-9998","dob":"1995-03-11","age":"","mstatus":"","insh":11007010,"cliId":"4JY0C64XP00","pno":5408774662,"cno":5408774662,"email":"","ename":"","eno":"","pphy":"SWEENEY, T KEVIN  ","ppno":4349773140,"pcpadd":"590 Peter Jefferson Pkwy Ste 100","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229114628,"pcpcounty":"","pcpid":"P9307501","pcpname":"SENTARA MARTHA JEFFERSON FAMILY MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"N","ano":"","add2":"","add3":"","madd1":"4 WEEMS LANE","madd2":"BOX 282  ","madd3":"","mcity":"WINCHESTER  ","mstate":"VA","mzip":"22601-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["G40.919","G40.409","G40.89","N20.0","F84.8","F79","Z68.24","A69.20","H66.93","Z86.19","G40.909","F84.0","R56.9","M25.511","G89.29","M25.561","M25.559","Z23","J30.9","E53.8","Z20.822"],"date":["2020-05-04","2020-09-11","2021-03-01","2019-04-04","2021-03-01","2021-03-01","2019-04-04","2019-06-19","2020-09-04","2020-09-04","2020-09-04","2020-09-11","2019-12-06","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2019-10-03","2021-03-01","2020-11-12","2021-09-16"],"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":[["","59762001601","CLINDAMYCIN","SOL 75MG\/5ML","","Select","Select",""],["","54356699","MIDAZOLAM","SYP 2MG\/ML","","Select","Select",""],["","50383007916","APAP\/CODEINE","SOL 120-12\/5","","Select","Select",""],["","70127010010","EPIDIOLEX","SOL 100MG\/ML","","Select","Select",""],["","51991065116","LEVETIRACETA","SOL 100MG\/ML","","Select","Select",""],["","50474050015","NAYZILAM","SPR 5MG","","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","","Select","Select",""],["","55111053201","DIVALPROEX","CAP 125MG","","Select","Select",""],["","591024201","LORAZEPAM","TAB 2MG","","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","","Select","Select",""],["","143998201","AMOX\/K CLAV","SUS 400\/5ML","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","69097012415","TOPIRAMATE","TAB 100MG","","Select","Select",""],["","406012301","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","55111053201","DIVALPROEX ","CAP 125MG","480","Select","Select",""],["","59762001601","CLINDAMYCIN ","SOL 75MG\/5ML","300","Select","Select",""],["","591024201","LORAZEPAM ","TAB 2MG","1","Select","Select",""],["","51991065116","LEVETIRACETA ","SOL 100MG\/ML","600","Select","Select",""],["","54356699","MIDAZOLAM ","SYP 2MG\/ML","300","Select","Select",""],["","16729013616","CLONAZEPAM ","TAB 0.5MG","120","Select","Select",""],["","69097012415","TOPIRAMATE ","TAB 100MG","120","Select","Select",""],["","50474050015","NAYZILAM ","SPR 5MG","4","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","406012301","HYDROCO\/APAP ","TAB 5-325MG","21","Select","Select",""],["","50383007916","APAP\/CODEINE ","SOL 120-12\/5","212","Select","Select",""],["","70127010010","EPIDIOLEX ","SOL 100MG\/ML","264","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","143998201","AMOX\/K ","SUS 400\/5ML","200","Select","Select",""],["","00143998201","AMOX\/K","400\/5ML","200","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":""}]}]}