{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRYSTAL M PIOS","gend":1,"add":"219 S MAIN ST  ","city":"GALAX ","state":"VA","zip":"24333-9998","dob":"1976-09-23","age":"","mstatus":"","insh":11009864,"cliId":"4NR8TX3WF36","pno":2767336177,"cno":2767336177,"email":"","ename":"","eno":"","pphy":"FANT, VANESSA  ","ppno":8007657130,"pcpadd":"400 S Independence Ave","pcpcity":"Independence","pcpstate":"VA","pcpzip":243483972,"pcpcounty":"","pcpid":"P0129331","pcpname":"OLDTOWN MEDICAL CARE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"APT 2 ","add3":"","madd1":"3211 FLOWER GAP RD","madd2":"","madd3":"","mcity":"CANA  ","mstate":"VA","mzip":"24317-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["K21.9","F34.1","F95.1","F43.12","F31.9","K31.84","R10.9","G25.9","G24.01","J30.1","E55.9","D50.9","E78.00","H04.121","H04.122","R11.2","R10.30","R19.7","K29.50","R14.0","K21.00","J45.909","Z72.0","K58.9","M19.90","F41.8","R11.0","R19.4","M51.36","M54.5","M62.830","F41.9","F32.9","Z79.899","Z23","F17.200","Z12.31","K59.00","R06.00","F90.9","Z00.01","I10","N39.46","Z00.00","Z12.4"],"date":["2021-07-27","2020-05-21","2020-01-06","2020-05-21","2021-10-25","2021-06-01","2020-01-13","2020-01-13","2021-06-03","2020-05-21","2020-04-02","2020-04-02","2020-05-21","2021-02-03","2021-02-03","2021-01-05","2021-01-05","2021-01-05","2020-10-12","2020-10-12","2020-10-12","2020-10-09","2020-10-09","2020-10-09","2020-10-09","2020-10-09","2020-10-12","2020-10-12","2021-01-20","2021-01-20","2021-01-20","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-07-27","2021-07-27","2020-10-12","2021-04-27","2021-04-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27"],"priorHcc":["","","","",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":[["","60505024801","MIRTAZAPINE","TAB 30MG","","Select","Select",""],["","42806008301","BUSPIRONE","TAB 7.5MG","","Select","Select",""],["","69238148403","ERYTHROMYCIN","TAB 250MG BS","","Select","Select",""],["","68382003516","VENLAFAXINE","CAP 75MG ER","","Select","Select",""],["","51991029301","OXCARBAZEPIN","TAB 300MG","","Select","Select",""],["","55111015905","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","64980037503","ATOMOXETINE","CAP 25MG","","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","","Select","Select",""],["","16729011917","MONTELUKAST","TAB 10MG","","Select","Select",""],["","69452024120","TRIHEXYPHEN","TAB 2MG","","Select","Select",""],["","70370108001","INGREZZA","CAP 80MG","","Select","Select",""],["","59651017301","DOXEPIN HCL","CAP 10MG","","Select","Select",""],["","55111068405","IBU","TAB 800MG","","Select","Select",""],["","527133010","BACLOFEN","TAB 10MG","","Select","Select",""],["","55111018010","TIZANIDINE","TAB 4MG","","Select","Select",""],["","69238148403","ERYTHROMYCIN ","TAB 250MG BS","45","Select","Select",""],["","55111064505","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","68180096301","ALBUTEROL ","AER HFA","8.5","Select","Select",""],["","68382003516","VENLAFAXINE ","CAP 75MG ER","90","Select","Select",""],["","51991029301","OXCARBAZEPIN ","TAB 300MG","60","Select","Select",""],["","60505024801","MIRTAZAPINE ","TAB 30MG","30","Select","Select",""],["","42806008301","BUSPIRONE ","TAB 7.5MG","90","Select","Select",""],["","67877019810","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","16729011917","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","64980037503","ATOMOXETINE ","CAP 25MG","30","Select","Select",""],["","70370108001","INGREZZA ","CAP 80MG","30","Select","Select",""],["","61442010201","DICLOFENAC ","TAB 50MG DR","60","Select","Select",""],["","59651017301","DOXEPIN ","CAP 10MG","270","Select","Select",""],["","69452024120","TRIHEXYPHEN ","TAB 2MG","180","Select","Select",""],["","55111068405","IBU ","800MG","30","Select","Select",""],["","527133010","BACLOFEN ","10MG","40","Select","Select",""],["","55111018010","TIZANIDINE ","4MG","14","Select","Select",""],["","68180096301","ALBUTEROL","HFA","8.5","Select","Select",""],["","67877019810","AMLODIPINE","5MG","30","Select","Select",""],["","59651017301","DOXEPIN","10MG","270","Select","Select",""],["","10702020110","OXYBUTYNIN","5MG","90","Select","Select",""],["","00378668910","PANTOPRAZOLE","40MG","90","Select","Select",""],["","10702020110","OXYBUTYNIN ","TAB 5MG","90","Select","Select",""],["","31722071310","PANTOPRAZOLE ","TAB 40MG","90","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":""}]}]}