{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROOSEVELT M DANIEL","gend":0,"add":"PO BOX 1243 ","city":"PAMPLIN  ","state":"VA","zip":"23958-0243","dob":"1965-10-30","age":"","mstatus":"","insh":11007530,"cliId":"7G86X18CG42","pno":4344267318,"cno":4344267318,"email":"","ename":"","eno":"","pphy":"GIBBS, PETER A","ppno":4342003908,"pcpadd":"1901 Thomson Dr,Ste A","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245011027,"pcpcounty":"","pcpid":"P9058801","pcpname":"LYNCHBURG INTERNAL MEDICINE A CENTRA HEALTH AFFIL","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 1243 ","madd2":"","madd3":"","mcity":"PAMPLIN  ","mstate":"VA","mzip":"23958-0243","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R69","E11.29","E11.9","I10","E55.9","I73.9","Z86.73","R26.89","Z23","G83.22","G83.24","Z89.422","R80.1","Z72.0","R53.83","R53.1","J11.1","I25.10","E78.00","E66.9","E11.51","Z79.82","Z79.84","Z79.899","Z88.8","F17.210","R05","I63.9","E11.43","S20.212A","W01.0XXA","E78.5","Z79.01","S29.9XXA","T14.90XA","Z00.00","S20.211A","M79.641","Y04.0XXA","S60.221A","S60.511A","Z79.02","S69.91XA","G90.9","R09.89","F41.9","E11.3393","R63.5","R20.0","E11.65","F14.10","G62.9","E11.40","I48.91","R20.8","E13.49","G56.01","R20.9","Z77.22"],"date":["2021-10-01","2020-07-14","2021-11-26","2021-11-26","2021-05-19","2021-10-13","2020-09-29","2020-02-03","2020-02-06","2020-02-06","2020-02-06","2020-02-06","2020-02-06","2021-10-13","2020-02-06","2020-02-06","2020-02-24","2020-09-29","2021-05-19","2020-09-29","2020-02-24","2020-09-29","2021-10-13","2020-09-29","2020-09-29","2020-02-24","2020-02-24","2021-05-30","2020-10-16","2020-09-29","2020-09-29","2021-11-26","2021-10-13","2020-09-29","2020-09-29","2020-10-09","2019-10-13","2021-11-13","2019-10-13","2019-10-13","2019-10-13","2019-10-13","2019-10-13","2020-10-16","2020-11-18","2020-10-16","2019-12-17","2021-05-19","2021-05-19","2021-08-19","2021-11-17","2021-10-13","2021-10-13","2021-10-13","2021-11-04","2021-11-16","2021-11-16","2021-11-16","2021-11-16"],"priorHcc":[null,"",null,null,"","","","","","","","","","","","","","","","","","","","","","","",null,"","","",null,"","","","","",null,"","","","","","","","","","","","",null,"","","",null,null,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":[["","55111019605","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","65702040810","ACCU-CHEK","TES AVIVA PL","","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","","Select","Select",""],["","13668011390","LOSARTAN POT","TAB 25MG","","Select","Select",""],["","832532511","POT CL MICRO","TAB 20MEQ ER","","Select","Select",""],["","50924097110","SOFTCLIX","MIS LANCETS","","Select","Select",""],["","68645054659","METFORMIN","TAB 1000MG","","Select","Select",""],["","16714081901","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","68645057454","GLIPIZIDE","TAB 5MG","","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","68382009405","CARVEDILOL","TAB 12.5MG","","Select","Select",""],["","55111019605","CLOPIDOGREL ","TAB 75MG","90","Select","Select",""],["","13668011390","LOSARTAN ","TAB 25MG","90","Select","Select",""],["","65702040810","ACCU-CHEK ","TES AVIVA PL","100","Select","Select",""],["","67877022310","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","50924097110","SOFTCLIX ","MIS LANCETS","100","Select","Select",""],["","832532511","POT  CL MICRO","TAB 20MEQ ER","90","Select","Select",""],["","68645057454","GLIPIZIDE ","TAB 5MG","180","Select","Select",""],["","68645054659","METFORMIN ","TAB 1000MG","180","Select","Select",""],["","68382009405","CARVEDILOL ","TAB 12.5MG","180","Select","Select",""],["","16714081901","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","43547028111","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","69238115403","EZETIMIBE ","10MG","30","Select","Select",""],["","13668011390","LOSARTAN","25MG","90","Select","Select",""],["","69238115403","EZETIMIBE","10MG","30","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","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","",""],["Yes","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":""}]}]}