{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GLADYS L STRANGE","gend":1,"add":"311 JEWELL STREET","city":"SOUTH BOSTON                  ","state":"VA","zip":"24592-9998","dob":"1957-05-15","age":"","mstatus":"","insh":11009466,"cliId":"8Q03QN5QG93","pno":4345755010,"cno":4345755010,"email":"","ename":"","eno":"","pphy":"KING, BRODERICK D                                           ","ppno":4345751336,"pcpadd":"101 Aubreys Loop,Ste C","pcpcity":"South Boston                  ","pcpstate":"VA","pcpzip":245925054,"pcpcounty":"","pcpid":"P0060083","pcpname":"HALIFAX PRIMARY CARE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"APARTMENT 19","add3":"","madd1":"311 JEWELL STREET","madd2":"APARTMENT 19","madd3":"","mcity":"SOUTH BOSTON                  ","mstate":"VA","mzip":"24592-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R26.89","Z89.512","F32.9","S88.112D","I10","E55.9","E78.00","Z12.31","M62.81","R26.81","Z74.09","F17.210","R91.8","R91.1","J98.4","R93.7","Z12.2","H25.813","H40.1134","Z86.010","Z11.59","R05"],"date":["2021-04-06","2020-09-16","2021-08-27","2020-12-10","2021-07-22","2021-07-22","2021-01-14","2021-02-04","2021-04-06","2021-04-06","2021-04-06","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2021-03-31","2021-03-31","2020-07-22","2021-07-22","2021-06-09"],"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":[["","378632477","VALSART\/HCTZ","TAB 320-12.5","","Select","Select",""],["","68180046907","LOVASTATIN","TAB 40MG","","Select","Select",""],["","43386005019","GAVILYTE-N","SOL FLAV PK","","Select","Select",""],["","24208046325","LATANOPROST","SOL 0.00005","","Select","Select",""],["","24208046325","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","378632477","VALSART\/HCTZ ","TAB 320-12.5","90","Select","Select",""],["","68180046907","LOVASTATIN ","TAB 40MG","90","Select","Select",""],["","43386005019","GAVILYTE-N ","SOL FLAV PK","4,000.00","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":""}]}]}