{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALMORE ARMSTEAD","gend":1,"add":"298 JOHN RANDOLPH RD ","city":"FARMVILLE","state":"VA","zip":"23901-9998","dob":"1941-06-18","age":"","mstatus":"","insh":11009019,"cliId":"9FG7YY9QW41","pno":4345473315,"cno":4348083815,"email":"","ename":"","eno":"","pphy":"ZAMAN, SAMIRA  ","ppno":4349245348,"pcpadd":"1221 Lee Street,1st Floor","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229080001,"pcpcounty":"","pcpid":"P0056388","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"298 JOHN RANDOLPH RD ","madd2":"","madd3":"","mcity":"FARMVILLE","mstate":"VA","mzip":"23901-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["J44.9","N18.2","I10","I73.9","E78.5","Z23","M25.512","M19.90","Z13.21","Z71.89","Z71.3","H34.8122","H25.813","H40.003","H40.2234","H25.13","H34.8120","Z00.00","H40.2224","H40.2213"],"date":["2020-09-09","2020-10-07","2020-10-07","2020-09-09","2020-09-09","2021-08-25","2020-01-29","2020-10-07","2020-10-07","2021-08-25","2020-10-07","2021-01-14","2021-09-24","2021-01-14","2021-02-05","2021-02-05","2020-12-31","2021-08-25","2021-09-24","2021-09-24"],"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":[["","67877019905","AMLODIPINE","TAB 10MG","","Select","Select",""],["","16729022701","SPIRONOLACT","TAB 100MG","","Select","Select",""],["","68382005005","MELOXICAM","TAB 7.5MG","","Select","Select",""],["","60505003306","PENTOXIFYLLI","TAB 400MG ER","","Select","Select",""],["","61314054701","LATANOPROST","SOL 0.00005","","Select","Select",""],["","68462040610","INDOMETHACIN","CAP 25MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","16729022701","SPIRONOLACT ","TAB 100MG","90","Select","Select",""],["","67877019905","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","60505003306","PENTOXIFYLLI ","TAB 400MG ER","180","Select","Select",""],["","31722054301","INDOMETHACIN ","CAP 50MG","30","Select","Select",""],["","68382005005","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","17","Select","Select",""],["","61314054701","LATANOPROST ","SOL 0.00005","7.5","Select","Select",""],["","00378965132","TRAVOPROST ","0.00004","2.5","Select","Select",""],["","42571014126","DORZOLAMIDE ","2% OP","20","Select","Select",""],["","59310057922","PROAIR","","17","Select","Select",""],["","00378965132","TRAVOPROST","0.00004","2.5","Select","Select",""],["","42571014126","DORZOLAMIDE","2% OP","20","Select","Select",""],["","00078090438","SIMBRINZA","1-0.2%","8","Select","Select",""],["","70727052925","ROCKLATAN","","2.5","Select","Select",""],["","00078090438","SIMBRINZA ","SUS 1-0.2%","8","Select","Select",""],["","70727052925","ROCKLATAN ","DRO ","2.5","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","",""],["Yes","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":""}]}]}