{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTHONY YOUNG SR","gend":0,"add":"9363 PARKER LANE  ","city":"EXMORE","state":"VA","zip":"23350-3965","dob":"1952-01-08","age":"","mstatus":"","insh":11009408,"cliId":"6W18FH6AM59","pno":7573877378,"cno":7573877378,"email":"","ename":"","eno":"","pphy":"CHICK, JON BLAIR  ","ppno":7573363682,"pcpadd":"4049 Main St","pcpcity":"Chincoteague Island  ","pcpstate":"VA","pcpzip":233362406,"pcpcounty":"","pcpid":"P9476151","pcpname":"EASTERN SHORE RURAL HEALTH SYSTEM","plan":"VPHP","program":"MEDICARE","lob":"DSNP","aligned":"Y","ano":"","add2":"","add3":"","madd1":"9363 PARKER LANE  ","madd2":"","madd3":"","mcity":"EXMORE","mstate":"VA","mzip":"23350-3965","region":"TIDEWATER","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R05","R06.89","I50.32","I34.0","I50.22","Z95.5","I10","I25.119","Z12.5","J43.9","I20.8","F17.210","R07.89","R07.9","R11.10","R06.02","R61","R20.2","I25.2","I25.10","F17.200","Z79.02","Z79.82","Z79.899","R94.31","Z09","I50.42","J84.9","Z87.891","Z20.828","K21.9","Z82.49","Z96.643","R11.2","I08.1","R94.39","I45.10","D61.818","I11.0","Z71.6","J44.9","E78.5","E78.00","Z98.890","I42.9","M25.551","M25.552","M19.90","R04.0","Z79.51","Z96.641","Z74.3","R79.1","Z86.79","I24.9","R07.2","I25.110","R68.89"],"date":["2020-01-06","2020-01-06","2020-12-23","2020-01-06","2020-01-06","2021-01-08","2021-04-28","2020-12-21","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-11-14","2020-12-24","2020-11-14","2020-12-15","2020-11-14","2020-11-14","2020-12-22","2020-12-23","2020-12-21","2020-12-22","2020-12-22","2020-12-22","2020-12-23","2021-01-08","2020-12-16","2020-12-16","2020-12-23","2020-12-22","2020-12-15","2020-12-15","2020-12-22","2020-12-15","2020-12-16","2020-12-21","2020-12-17","2020-12-21","2020-12-21","2020-12-21","2020-12-22","2020-12-21","2020-12-21","2021-01-08","2020-05-17","2020-05-17","2020-05-17","2020-12-22","2020-05-17","2020-05-17","2020-05-17","2020-11-14","2020-12-15","2020-12-16","2020-12-23","2020-12-21","2020-12-22","2020-12-22"],"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":[["","62175011937","ISOSORB MONO","TAB 60MG ER","","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","378395305","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","55111019605","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","53746051105","SPIRONOLACT","TAB 25MG","","Select","Select",""],["","68382056401","METOPROL SUC","TAB 25MG ER","","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","43598043501","NITROGLYCERN","SUB 0.3MG","","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","","Select","Select",""],["","69046856","CHANTIX","TAB 0.5MG","","Select","Select",""],["","53746051105","SPIRONOLACT ","TAB 25MG","45","Select","Select",""],["","65862056090","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","378395305","ATORVASTATIN ","TAB 80MG","90","Select","Select",""],["","68382056401","METOPROL ","TAB 25MG ER","90","Select","Select",""],["","62175011937","ISOSORB ","TAB 60MG ER","30","Select","Select",""],["","55111019605","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","76204020025","ALBUTEROL ","NEB 0.00083","375","Select","Select",""],["","69046856","CHANTIX ","0.5MG","180","Select","Select",""],["","43598043501","NITROGLYCERN ","0.3MG","100","Select","Select",""],["","68382056401","METOPROL","25MG ER","90","Select","Select",""],["","62175011937","ISOSORB","60MG ER","30","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":""}]}]}