{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIAN G DEAVER","gend":1,"add":"7211 NORWOOD POND CT ","city":"MIDLOTHIAN  ","state":"VA","zip":"23112-9998","dob":"1960-06-04","age":"","mstatus":"","insh":11008424,"cliId":"3WY7HN4QR41","pno":8046395709,"cno":8046395709,"email":"","ename":"","eno":"","pphy":"SHAH, AMAR RAJENDRA  ","ppno":8042568282,"pcpadd":"4700 Puddledock Rd Ste 300","pcpcity":"Prince George  ","pcpstate":"VA","pcpzip":238751268,"pcpcounty":"","pcpid":"P0139689","pcpname":"VITALCARE FAMILY LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"N","ano":"","add2":"","add3":"","madd1":"11901 CARTERS VALLEY TERRACE  ","madd2":"","madd3":"","mcity":"CHESTERFIELD","mstate":"VA","mzip":"23838-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M17.11","M25.561","M25.562","M21.061","E78.5","M32.9","F79","R42","Z87.891","Z79.82","Z01.810","G89.18","Z47.1","Z96.651","K52.9","R10.9","R11.10","F71","R07.9","E78.2","R10.13","R53.83","M17.0","M25.551","Z79.899","Z00.00","Z11.1","Z12.39","Z23","H91.93","R41.3","S00.31XA","S00.81XA","S80.219A","W19.XXXA","Z68.29","M17.10","H52.4","Z12.11","M17.12","Z20.822","M15.9","K21.9","J30.9","R09.82","M06.9","Z68.27","M79.671","S93.601A","M17.9","M25.571","R73.03","Z78.0","Z13.820","J06.9","Z92.29","R11.0","U07.1","L93.0","M21.062","M25.762","R82.90","I10","M79.4","Z04.9","M25.662","M62.81","R26.89"],"date":["2020-02-25","2020-01-31","2021-09-30","2020-02-18","2021-09-30","2021-11-24","2021-09-03","2020-02-18","2021-09-30","2020-06-20","2020-02-18","2021-10-18","2021-10-25","2021-08-19","2020-04-07","2020-04-07","2020-04-07","2020-04-07","2020-04-07","2020-06-20","2020-04-16","2020-04-16","2020-04-16","2021-05-19","2021-11-24","2021-08-16","2021-08-16","2021-08-16","2021-11-24","2020-07-02","2020-10-16","2019-09-19","2019-09-19","2019-09-19","2019-09-19","2019-09-19","2019-10-16","2019-10-24","2019-11-16","2021-10-18","2021-09-03","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2021-03-23","2021-03-23","2021-11-24","2021-11-24","2021-08-16","2021-08-16","2021-08-16","2021-07-12","2021-07-12","2021-08-25","2021-09-03","2021-09-03","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-11-16","2021-11-16","2021-11-16"],"priorHcc":["","","","","",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":[["","68382009601","HYDROXYCHLOR","TAB 200MG","","Select","Select",""],["","58160088552","FLUARIX QUAD","INJ 2020-21","","Select","Select",""],["","16714068403","SIMVASTATIN","TAB 40MG","","Select","Select",""],["","93005805","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","64764008060","AMITIZA","CAP 8MCG","","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","68382009601","HYDROXYCHLOR ","TAB 200MG","31","Select","Select",""],["","16714068403","SIMVASTATIN ","TAB 40MG","31","Select","Select",""],["","58160088552","FLUARIX ","INJ 2020-21","0.5","Select","Select",""],["","93005805","TRAMADOL ","TAB 50MG","20","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","10","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","64764008060","AMITIZA ","CAP 8MCG","4","Select","Select",""],["","58160088552","FLUARIX","2020-21","0.5","Select","Select",""],["","00093005805","TRAMADOL","50MG","20","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","10","Select","Select",""],["","45802005505","TRIAMCINOLON","0.10%","15","Select","Select",""],["","57237023305","SMZ-TMP","800-160","6","Select","Select",""],["","57237023305","SMZ-TMP ","TAB 800-160","6","Select","Select",""],["","13107005501","OXYCODONE ","TAB 5MG","42","Select","Select",""],["","45802005505","TRIAMCINOLON ","OIN 0.001","15","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":""}]}]}