{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAY S JORDAN","gend":0,"add":"356 E FUDGE ST ","city":"COVINGTON","state":"VA","zip":"24426-9998","dob":"1962-12-09","age":"","mstatus":"","insh":11007346,"cliId":"4W94CN9EG92","pno":5406207239,"cno":5406207239,"email":"","ename":"","eno":"","pphy":"BALLOU, MICHELE","ppno":5408626777,"pcpadd":"200 Arh Ln Ste 102","pcpcity":"Low Moor ","pcpstate":"VA","pcpzip":24457,"pcpcounty":"","pcpid":"P0148532","pcpname":"WVVA HEALTHCARE ALLIANCE PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"APT A ","add3":"","madd1":"356 E FUDGE ST ","madd2":"APT A ","madd3":"","mcity":"COVINGTON","mstate":"VA","mzip":"24426-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["H54.8","Z71.9","J45.909","I10","H40.52X4","M23.91","I67.1","M76.50","S00.83XA","M54.2","R51","W01.0XXA","H54.7","J44.9","K21.9","W10.9XXA","H40.1114","Z23","Z00.00","A41.9","J96.01","J44.0","J44.1","N17.9","F17.200","J20.9","Z79.51","Z79.83","H40.9","R06.02","F17.290","A08.4","R10.9","E87.5","R91.8","J98.4","R05","U07.1","J12.82","J45.901","F41.9","Z79.52","Z72.0","J18.9","R91.1","M16.11","J45.50","E78.5","Z86.16","F17.210"],"date":["2021-11-23","2020-02-18","2021-02-25","2021-06-21","2021-11-11","2019-10-22","2019-08-16","2019-08-16","2019-08-19","2019-08-19","2019-08-19","2019-08-19","2019-08-19","2020-12-31","2021-06-21","2019-08-19","2021-05-06","2020-10-14","2019-10-18","2019-11-04","2021-02-10","2021-02-09","2021-02-10","2019-11-03","2021-02-09","2019-11-03","2020-12-31","2019-11-03","2021-06-21","2021-02-09","2019-11-04","2020-12-31","2020-12-31","2020-12-31","2021-06-02","2021-02-09","2021-02-09","2021-03-31","2021-06-02","2021-02-10","2021-02-09","2021-02-09","2021-02-09","2021-06-02","2021-06-21","2021-06-02","2021-06-21","2021-06-21","2021-06-21","2021-06-21"],"priorHcc":[null,"","","",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":[["","55111064530","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","69097022416","ALENDRONATE","TAB 70MG","","Select","Select",""],["","42571014126","DORZOLAMIDE","SOL 2% OP","","Select","Select",""],["","61314054701","LATANOPROST","SOL 0.00005","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","50383023310","DORZOL\/TIMOL","SOL 22.3-6.8","","Select","Select",""],["","23932105","ALPHAGAN P","SOL 0.001","","Select","Select",""],["","66993058697","FLUTIC\/SALME","AER 500\/50","","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","","Select","Select",""],["","591505210","PREDNISONE","TAB 5MG","","Select","Select",""],["","186037020","SYMBICORT","AER 160-4.5","","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","","Select","Select",""],["","173069700","ADVAIR DISKU","AER 500\/50","","Select","Select",""],["","50111078810","AZITHROMYCIN","TAB 500MG","","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","","Select","Select",""],["","55111015930","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","23932105","ALPHAGAN ","SOL 0.001","5","Select","Select",""],["","66993058697","FLUTIC\/SALME ","AER 500\/50","60","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","69097022416","ALENDRONATE ","TAB 70MG","4","Select","Select",""],["","42571014126","DORZOLAMIDE ","SOL 2% OP","10","Select","Select",""],["","61314054701","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","50383023310","DORZOL\/TIMOL ","SOL 22.3-6.8","10","Select","Select",""],["","591505210","PREDNISONE ","TAB 5MG","90","Select","Select",""],["","68180096301","ALBUTEROL ","AER HFA","8.5","Select","Select",""],["","29300022019","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","173069700","ADVAIR ","AER 500\/50","60","Select","Select",""],["","173068220","VENTOLIN ","AER ","18","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","50111078810","AZITHROMYCIN ","TAB 500MG","3","Select","Select",""],["","68645051554","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","00023932105","ALPHAGAN","0.001","5","Select","Select",""],["","00173069700","ADVAIR","500\/50","60","Select","Select",""],["","00173068220","VENTOLIN","","18","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":""}]}]}