{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEVEN L RALEIGH JR","gend":0,"add":"1048 HOLLY COURT  ","city":"ESSERVILLE  ","state":"VA","zip":"24273-9998","dob":"1989-02-18","age":"","mstatus":"","insh":11009081,"cliId":"1Q56PF3DA83","pno":2766792870,"cno":2766792870,"email":"","ename":"","eno":"","pphy":"HANOR, STEVE","ppno":4238441121,"pcpadd":"1 Medical Park Blvd.","pcpcity":"Bristol  ","pcpstate":"TN","pcpzip":376207430,"pcpcounty":"","pcpid":"P9059215","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1048 HOLLY COURT  ","madd2":"","madd3":"","mcity":"ESSERVILLE  ","mstate":"VA","mzip":"24273-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["H65.193","K21.9","L81.4","D22.71","D22.61","D22.62","L57.0","G43.109","C44.319","R00.2","R07.89","Z88.0","I10","D22.5","L21.8","L02.222","R51","H52.4","G89.4","M17.11","M17.12","M19.041","M19.042","M19.031","M19.032","H36","Z68.32","F17.220","Z97.3","J30.9","J45.909","G47.30","R01.1","F41.1","F32.89","E03.9","Z23","H16.223","H02.88A","H02.88B"],"date":["2020-03-31","2020-10-18","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2020-10-18","2020-10-18","2019-11-19","2019-11-11","2019-11-11","2020-11-11","2019-11-13","2021-03-09","2021-03-09","2020-07-23","2020-10-18","2020-10-18","2020-10-18","2020-10-18","2020-10-18","2020-10-18","2020-10-18","2020-10-18","2020-10-18","2020-10-18","2020-10-18","2020-10-18","2020-10-18","2020-10-18","2020-10-18","2020-10-18","2020-10-18","2020-10-18","2020-10-18","2019-12-18","2021-06-28","2021-06-28","2021-06-28"],"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":[["","65862014736","SUMATRIPTAN","TAB 50MG","","Select","Select",""],["","68382078201","DOXYCYC MONO","CAP 50MG","","Select","Select",""],["","228277811","PROPRANOLOL","CAP 60MG ER","","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","","Select","Select",""],["","45802093716","HYDROCORT","LOT 0.025","","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","59651000330","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","65862014736","SUMATRIPTAN ","TAB 50MG","9","Select","Select",""],["","45802093716","HYDROCORT ","LOT 0.025","59","Select","Select",""],["","45802046564","KETOCONAZOLE ","SHA 0.02","120","Select","Select",""],["","60758011905","PREDNISOLONE ","SUS 1% OP","10","Select","Select",""],["","68382078201","DOXYCYC ","CAP 50MG","180","Select","Select",""],["","228277811","PROPRANOLOL ","CAP 60MG ER","30","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","54327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","68645014059","FAMOTIDINE ","20MG","60","Select","Select",""],["","59651000330","OMEPRAZOLE ","40MG","30","Select","Select",""],["","50111078710","AZITHROMYCIN ","250MG","6","Select","Select",""],["","68382078201","DOXYCYC","50MG","180","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":""}]}]}