{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY A DOSS","gend":1,"add":"406 DOSWELL ST ","city":"FARMVILLE","state":"VA","zip":"23901-1676","dob":"1950-11-30","age":"","mstatus":"","insh":11009719,"cliId":"2RF3WF6AC13","pno":4346031056,"cno":4345746711,"email":"","ename":"","eno":"","pphy":"DISPASQUALE-SEELIG, KATHLEEN  ","ppno":8042923011,"pcpadd":"180 E BELT DR","pcpcity":"HENRICO  ","pcpstate":"VA","pcpzip":232281204,"pcpcounty":"","pcpid":"P0124081","pcpname":"THE DAILY PLANET INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APARTMENT O ","add3":"","madd1":"406 DOSWELL ST ","madd2":"APARTMENT O ","madd3":"","mcity":"FARMVILLE","mstate":"VA","mzip":"23901-1676","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M79.7","F32.9","F41.9","I10","I65.22","J45.909","M62.81","E78.5","F17.210","Z91.81","Z11.59","L30.9","Z71.89","Z71.3","H25.813","L40.9","M79.605","F17.200","E78.00","H25.812","H25.13","H25.12","Z20.822","F41.8","Z72.89","F12.90","I70.213","Z86.73","H25.811","H25.11","Z79.899","I73.9","Z23","N28.9"],"date":["2021-10-20","2021-07-19","2021-10-20","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2021-06-21","2021-06-21","2020-11-05","2020-12-03","2021-10-20","2021-10-20","2021-06-02","2021-10-20","2021-03-15","2021-04-05","2021-06-21","2021-05-17","2021-05-07","2021-05-17","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-06-01","2021-06-01","2021-06-21","2021-06-21","2021-06-21","2021-06-01","2021-10-28","2021-10-20"],"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":[["","16729017117","AMITRIPTYLIN","TAB 10MG","","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","","Select","Select",""],["","62175089043","ATORVASTATIN","TAB 10MG","","Select","Select",""],["","59762121103","DESVENLAFAX","TAB 50MG ER","","Select","Select",""],["","23155019201","BUPROPION","TAB 100MG","","Select","Select",""],["","51672128202","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","93506105","HYDROXYZ HCL","TAB 25MG","","Select","Select",""],["","60432013350","CLOBETASOL","SOL 0.0005","","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","","Select","Select",""],["","60432046608","DEXAMETHASON","ELX 0.5\/5ML","","Select","Select",""],["","16729017117","AMITRIPTYLIN ","TAB 10MG","30","Select","Select",""],["","16729013616","CLONAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","43547040011","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","62175089043","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","60432013350","CLOBETASOL ","SOL 0.0005","50","Select","Select",""],["","59762121103","DESVENLAFAX ","TAB 50MG ER","90","Select","Select",""],["","23155019201","BUPROPION ","TAB 100MG","90","Select","Select",""],["","51672128202","TRIAMCINOLON ","CRE 0.001","30","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","90","Select","Select",""],["","93506105","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","17478071310","OFLOXACIN ","DRO 0.3% OP","5","Select","Select",""],["","60758011905","PREDNISOLONE ","SUS 1% OP","5","Select","Select",""],["","50383077504","LIDOCAINE ","SOL 2% VISC","25","Select","Select",""],["","60432046608","DEXAMETHASON ","ELX 0.5\/5ML","300","Select","Select",""],["","60758077305","KETOROLAC ","0.40%","5","Select","Select",""],["","60758077305","KETOROLAC","0.004","5","Select","Select",""],["","60758011905","PREDNISOLONE","1% OP","5","Select","Select",""],["","00093506105","HYDROXYZ","25MG","30","Select","Select",""],["","17478071310","OFLOXACIN","0.3% OP","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","",""],["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":""}]}]}