{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BHANUBEN J GANDHI","gend":1,"add":"294 N COUNTY DR","city":"WAKEFIELD","state":"VA","zip":"23888-9998","dob":"1952-02-27","age":"","mstatus":"","insh":11007680,"cliId":"8Y64WH6GP06","pno":8323627843,"cno":"","email":"","ename":"","eno":"","pphy":"COLEMAN, GEORGE C","ppno":8048348871,"pcpadd":"344 W Main St","pcpcity":"Waverly  ","pcpstate":"VA","pcpzip":238903235,"pcpcounty":"Sussex","pcpid":"P9059198","pcpname":"WAVERLY MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"N","ano":"","add2":"#112  ","add3":"","madd1":"294 N COUNTY DR","madd2":"#112  ","madd3":"","mcity":"WAKEFIELD","mstate":"VA","mzip":"23888-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","K21.9","H60.61","L29.9","M54.9","H90.3","H26.9","N81.2","L30.9","H90.6","H92.12","H92.13","H90.A32","H72.91"],"date":["2021-04-26","2021-04-26","2021-04-26","2021-01-25","2021-01-25","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-05-24"],"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":[["","46087221","PREMARIN VAG","CRE 0.625MG","","Select","Select",""],["","13668042905","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","57237022405","RAMIPRIL","CAP 5MG","","Select","Select",""],["","61314064511","NEO\/POLY\/HC","SUS 1% OTIC","","Select","Select",""],["","45802006435","TRIAMCINOLON ","CRE 0.001","30","Select","Select",""],["","68382014601","RAMIPRIL ","CAP 5MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","46087221","PREMARIN ","CRE 0.625MG","30","Select","Select",""],["","61314064511","NEO\/POLY\/HC ","SUS 1% OTIC","10","Select","Select",""],["","24208041005","OFLOXACIN ","0.3%OTIC","5","Select","Select",""],["","45802006435","TRIAMCINOLON","0.001","30","Select","Select",""],["","00046087221","PREMARIN","0.625MG","30","Select","Select",""],["","24208041005","OFLOXACIN","0.3%OTIC","5","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":""}]}]}