{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REGINA E KIRBY","gend":1,"add":"49SANDSTONE LANE  ","city":"GALAX ","state":"VA","zip":"24333-3528","dob":"1973-08-20","age":"","mstatus":"","insh":11008294,"cliId":"5RT8YN3YU50","pno":2762381773,"cno":2762381773,"email":"","ename":"","eno":"","pphy":"FANT, VANESSA  ","ppno":8007657130,"pcpadd":"400 S Independence Ave","pcpcity":"Independence","pcpstate":"VA","pcpzip":243483972,"pcpcounty":"","pcpid":"P0129331","pcpname":"OLDTOWN MEDICAL CARE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"49SANDSTONE LANE  ","madd2":"","madd3":"","mcity":"GALAX ","mstate":"VA","mzip":"24333-3528","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F41.9","F71","Z23","R55","B35.3","E66.3","Z12.31","H01.013","H01.016","R15.2","H61.21","H66.91","K58.0","Z79.899","F72"],"date":["2021-11-16","2021-05-25","2021-11-16","2020-10-28","2021-05-25","2019-12-04","2021-11-16","2021-04-27","2021-04-27","2021-05-25","2021-05-25","2021-11-16","2021-11-16","2021-11-16","2021-11-16"],"priorHcc":[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":[["","65862001105","SERTRALINE","TAB 25MG","","Select","Select",""],["","68382003516","VENLAFAXINE","CAP 75MG ER","","Select","Select",""],["","172392670","DIAZEPAM","TAB 5MG","","Select","Select",""],["","58160089652","FLUARIX QUAD","INJ 2019-20","","Select","Select",""],["","68382003416","VENLAFAXINE ","CAP 37.5 ER","30","Select","Select",""],["","65862001105","SERTRALINE ","TAB 25MG","30","Select","Select",""],["","172392670","DIAZEPAM ","TAB 5MG","5","Select","Select",""],["","58160089652","FLUARIX ","INJ 2019-20","0.5","Select","Select",""],["","69315091001","DIPHEN\/ATROP ","","45","Select","Select",""],["","58160089652","FLUARIX","2019-20","0.5","Select","Select",""],["","69315091001","DIPHEN\/ATROP","","45","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":""}]}]}