{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RHONDA L RICHARDSON","gend":1,"add":"18311 BEAZLEY LANE","city":"MILFORD  ","state":"VA","zip":"22514-9998","dob":"1953-02-17","age":"","mstatus":"","insh":11010086,"cliId":"1M56V77AR56","pno":8045122763,"cno":8045122763,"email":"","ename":"","eno":"","pphy":"BASHORE, RANDALL T","ppno":4345813271,"pcpadd":"2217 Princess Anne St,Ste 100-2","pcpcity":"Fredericksburg ","pcpstate":"VA","pcpzip":224013359,"pcpcounty":"","pcpid":"P0060340","pcpname":"CAROLINE FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"18311 BEAZLEY LANE","madd2":"","madd3":"","mcity":"MILFORD  ","mstate":"VA","mzip":"22514-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M99.01","M99.02","M50.322","K21.9","I10","Z87.19","K57.30","Z86.010","H25.13","E78.5","Z71.89","E05.90","E03.8","R12","K58.2","M54.2","F17.200","J30.89","G47.62","H50.9","Z23","Z12.31","M85.89","Z78.0","Z80.3","Z13.820","R30.0","Z71.3","Z00.00","Z11.59","E55.9","Z68.24","M85.80","R79.89","H69.83","J30.9","R06.2"],"date":["2021-11-10","2021-11-10","2021-11-10","2021-11-17","2021-11-17","2020-03-03","2020-03-03","2020-03-03","2020-05-29","2021-11-17","2021-04-27","2020-12-16","2020-06-08","2021-06-16","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2021-04-27","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-04-27","2021-04-27","2021-04-06","2021-06-16","2021-06-16","2021-06-16","2021-11-17","2021-11-22","2021-06-16","2021-11-17","2021-11-17"],"priorHcc":[null,null,null,null,null,"","","","",null,"","","","","","","","","","","","","","","","","","","","","","",null,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":[["","62175011832","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","70377000415","SIMVASTATIN","TAB 40MG","","Select","Select",""],["","378081001","HYDROCHLOROT","CAP 12.5MG","","Select","Select",""],["","378520977","AMLODIPINE","TAB 5MG","","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","","Select","Select",""],["","185012201","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","62175011832","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","378520977","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","70377000415","SIMVASTATIN ","TAB 40MG","90","Select","Select",""],["","378081001","HYDROCHLOROT ","CAP 12.5MG","90","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","64380076921","PEG-3350\/KCL ","SOL \/SODIUM","4,000.00","Select","Select",""],["","00185012201","NITROFURANTN","100MG","14","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":""}]}]}