{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM H RILEY","gend":0,"add":"149-9 STEVENSON RD","city":"STEPHENSON  ","state":"VA","zip":"22656-9998","dob":"1954-10-22","age":"","mstatus":"","insh":11009691,"cliId":"9U76WD8PP56","pno":5402330629,"cno":5402330629,"email":"","ename":"","eno":"","pphy":"ARMSTRONG, JOHN H ","ppno":5406782800,"pcpadd":"104 Selma Dr","pcpcity":"Winchester  ","pcpstate":"VA","pcpzip":226013834,"pcpcounty":"","pcpid":"P9059049","pcpname":"SELMA MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"149-9 STEVENSON RD","madd2":"","madd3":"","mcity":"STEPHENSON  ","mstate":"VA","mzip":"22656-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["T21.12XA","T22.192A","T23.102A","T31.0","X12.XXXA","T21.22XD","X12.XXXD","T21.02XD","Z23","R10.9","Z51.89","E78.2","E11.9","I10","E55.9","E53.8","N52.9","F33.41","R39.9","K22.70","I20.9","E11.42","E11.65","K21.9","Z79.82","H90.3","M17.12","M54.5","E66.9","I25.10","G47.33","M54.2","D50.9","Z68.34","M25.531","F17.200","H40.9","Z72.0","M18.9","R07.9","V89.2XXA","M54.6","R06.02","R07.2","R05","Z20.822","H40.1132","H25.13","R07.89","F33.1","F41.8","F43.21","F32.9","G89.4","H35.711"],"date":["2020-03-17","2020-03-17","2020-03-17","2020-03-20","2020-03-17","2020-03-20","2020-03-20","2020-03-23","2020-03-23","2020-03-26","2020-03-26","2021-06-24","2021-11-08","2021-08-24","2020-07-03","2020-07-03","2020-07-03","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-06-24","2021-08-24","2020-07-03","2020-07-03","2021-08-24","2020-07-03","2020-07-03","2021-08-24","2021-01-20","2020-07-16","2020-07-03","2020-07-03","2020-07-03","2021-08-24","2021-08-24","2020-07-03","2020-07-03","2021-01-12","2020-07-16","2020-07-16","2021-01-12","2021-01-12","2021-01-12","2021-06-01","2021-01-18","2021-11-08","2021-01-20","2021-01-20","2021-06-01","2021-06-01","2021-06-01","2021-08-24","2021-11-08"],"priorHcc":["","","","","","","","","","","","",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":[["","53746010901","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","93312501","DICLOXACILL","CAP 500MG","","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","","Select","Select",""],["","68382003516","VENLAFAXINE","CAP 75MG ER","","Select","Select",""],["","378247401","DICLOFEN POT","TAB 50MG","","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","","Select","Select",""],["","13668042990","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","68382002310","ATENOLOL","TAB 50MG","","Select","Select",""],["","24208046325","LATANOPROST","SOL 0.00005","","Select","Select",""],["","68382025116","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","59746036390","VALSARTAN","TAB 320MG","","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","","Select","Select",""],["","67877012450","SILVER SULFA","CRE 0.01","","Select","Select",""],["","51672401801","ETODOLAC","TAB 400MG","","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","5","Select","Select",""],["","68382003516","VENLAFAXINE ","CAP 75MG ER","90","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","270","Select","Select",""],["","93312501","DICLOXACILL ","CAP 500MG","20","Select","Select",""],["","24208046325","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","67877012450","SILVER ","CRE 0.01","50","Select","Select",""],["","378247401","DICLOFEN ","TAB 50MG","180","Select","Select",""],["","13668042990","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","68382002310","ATENOLOL ","TAB 50MG","90","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","68382075810","METFORMIN ","TAB 500MG","360","Select","Select",""],["","68382025116","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","59746036390","VALSARTAN ","TAB 320MG","90","Select","Select",""],["","51672401801","ETODOLAC ","TAB 400MG","20","Select","Select",""],["","00378247401","DICLOFEN","50MG","180","Select","Select",""],["","67877012450","SILVER","0.01","50","Select","Select",""],["","24208048610","DORZOL\/TIMOL ","SOL 22.3-6.8","10","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}