{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BARBARA WALTERS","gend":1,"add":"202BEAVER'S MILL ROAD","city":"DANVILLE ","state":"VA","zip":"24540-1558","dob":"1944-08-10","age":"","mstatus":"","insh":11007446,"cliId":"4H37RD1FF36","pno":8044373239,"cno":8044373239,"email":"","ename":"","eno":"","pphy":"ADDIS, DANIEL M","ppno":4347917366,"pcpadd":"219 Parker Rd","pcpcity":"Danville ","pcpstate":"VA","pcpzip":245404034,"pcpcounty":"","pcpid":"P0060036","pcpname":"PIEDMONT FAMILY AND OCCUPATIONAL MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"APT H ","add3":"","madd1":"202BEAVER'S MILL ROAD","madd2":"APT H ","madd3":"","mcity":"DANVILLE ","mstate":"VA","mzip":"24540-1558","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R74.0","R74.8","Z12.11","I10","E11.9","E78.5","E55.9","R01.1","E66.9","C50.919","Z79.84","N18.2","M54.17","M54.9","Z88.8","K57.30","K64.1","K21.9","Z85.3","Z90.11","Z79.82","K57.32","K56.2","Z71.3","Z71.82","E66.3","N18.3","N13.39","M79.673","M20.40","M20.10","M86.9","E87.1","E87.6","Z80.9","M19.071","N13.30","Z00.00","Z00.01","R74.02","K57.90","R94.5","Z23","R74.01","N18.9","Z91.14","C85.90","Z77.22","R93.3","R63.4","R13.10","H40.023","H25.13","H35.40","Z13.1","Z13.220","H25.813","D23.9"],"date":["2020-01-03","2021-05-10","2021-05-10","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-08-11","2021-03-22","2021-06-15","2021-06-15","2021-08-12","2020-02-19","2020-02-19","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2021-06-15","2021-06-15","2021-06-15","2020-06-29","2020-11-18","2019-08-08","2019-08-08","2019-08-08","2019-07-11","2020-07-14","2021-08-12","2021-05-10","2019-08-08","2021-02-08","2021-09-27","2021-09-27","2021-05-10","2021-05-10","2020-10-07","2021-09-27","2020-10-14","2020-10-20","2020-10-20","2019-11-06","2019-11-06","2021-05-10","2021-05-10","2021-05-10","2021-10-05","2021-04-05","2021-04-05","2021-09-27","2021-09-27","2021-10-05","2021-10-05"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","",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":[["","68382007016","PRAVASTATIN","TAB 10MG","","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","","Select","Select",""],["","99073070822","FREESTYLE","TES LITE","","Select","Select",""],["","50742061710","METOPROL SUC","TAB 100MG ER","","Select","Select",""],["","6027754","JANUVIA","TAB 100MG","","Select","Select",""],["","68645057290","GLIMEPIRIDE","TAB 2MG","","Select","Select",""],["","50111039801","HYDRALAZINE","TAB 10MG","","Select","Select",""],["","49281012065","FLUZONE HD","INJ PF 20-21","","Select","Select",""],["","93005805","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","68382007016","PRAVASTATIN ","TAB 10MG","90","Select","Select",""],["","68645051554","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","TES LITE","50","Select","Select",""],["","50742061710","METOPROL ","TAB 100MG ER","90","Select","Select",""],["","93005805","TRAMADOL ","TAB 50MG","15","Select","Select",""],["","6027754","JANUVIA ","TAB 100MG","90","Select","Select",""],["","68645057290","GLIMEPIRIDE ","TAB 2MG","90","Select","Select",""],["","49281012065","FLUZONE ","INJ PF 20-21","0.7","Select","Select",""],["","50111039801","HYDRALAZINE ","10MG","30","Select","Select",""],["","99073013001","FREESTYLE MIS LANCETS","LANCETS","100","Select","Select",""],["","99073070827","FREESTYLE TES LITE","LITE","100","Select","Select",""],["","50742061710","METOPROL","100MG ER","90","Select","Select",""],["","00093005805","TRAMADOL","50MG","15","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","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":""}]}]}