{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROLAND C JUBILEE JR","gend":0,"add":"17400 COAL KILN ROAD ","city":"PAINTER  ","state":"VA","zip":"23420-9998","dob":"1946-06-14","age":"","mstatus":"","insh":11010156,"cliId":"9TR4EX2NR94","pno":7576077826,"cno":7576077826,"email":"","ename":"","eno":"","pphy":"HALLS, ALBERT JOHN","ppno":7577877374,"pcpadd":"20306 Badger Ln","pcpcity":"Onancock ","pcpstate":"VA","pcpzip":234171224,"pcpcounty":"","pcpid":"P9058920","pcpname":"ONLEY COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 434  ","madd2":"","madd3":"","mcity":"PAINTER  ","mstate":"VA","mzip":"23420-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["K59.00","K62.5","E11.22","I12.9","N18.9","E78.00","Z85.46","Z87.891","Z92.3","Z00.00","B35.1","L85.1","E11.40","E11.9","D50.8","I50.9","Z68.41","Z12.11","K57.31","K92.1","D12.0","D12.5","K62.89","K64.0","Z90.79","N18.2","D63.1","Z79.82","Z79.84","Z79.899","K57.30","E66.01","D64.9","J30.2","D50.9","K44.9","K25.9","J45.909","Z91.048","J39.2","M19.071","M25.671","C61","I10","E78.5","I87.8","R01.1","L30.9","Z28.21","I08.8","R23.4","N18.30","Z68.42","M77.41","M77.42","M79.89","L57.0","M17.10","R97.20"],"date":["2020-01-16","2020-01-16","2021-07-27","2020-04-20","2020-01-16","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2020-01-16","2021-08-09","2021-08-09","2021-08-09","2021-11-15","2020-10-29","2021-01-19","2021-10-29","2020-03-10","2020-03-09","2020-04-02","2020-03-10","2020-03-10","2020-03-09","2020-03-09","2020-03-09","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2020-03-09","2021-10-29","2020-03-31","2020-04-02","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2020-05-04","2020-05-04","2021-03-01","2021-07-27","2021-10-29","2020-07-27","2020-11-25","2020-10-29","2020-10-29","2020-11-26","2020-12-07","2021-07-27","2021-07-27","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-04-23","2021-10-29"],"priorHcc":["","","","","","","","","","","","","",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":[["","68180038909","FENOFIBRATE","TAB 145MG","","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","57664047758","METOPROL TAR","TAB 50MG","","Select","Select",""],["","51672128902","NYSTATIN","CRE 100000","","Select","Select",""],["","10370074501","GLIPIZIDE ER","TAB 5MG","","Select","Select",""],["","378021610","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","50228014610","HYDROCHLOROT","CAP 12.5MG","","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","","Select","Select",""],["","93727298","PIOGLITAZONE","TAB 30MG","","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","228212750","CLONIDINE","TAB 0.1MG","","Select","Select",""],["","68180051703","LISINOPRIL","TAB 40MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","228212750","CLONIDINE ","TAB 0.1MG","90","Select","Select",""],["","10370074501","GLIPIZIDE ","TAB 5MG","180","Select","Select",""],["","68180038909","FENOFIBRATE ","TAB 145MG","90","Select","Select",""],["","50228014610","HYDROCHLOROT ","CAP 12.5MG","90","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","93727298","PIOGLITAZONE ","TAB 30MG","90","Select","Select",""],["","378021610","FUROSEMIDE ","TAB 40MG","90","Select","Select",""],["","51672128902","NYSTATIN ","CRE 100000","60","Select","Select",""],["","57664047758","METOPROL ","TAB 50MG","90","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","68180051703","LISINOPRIL ","TAB 40MG","180","Select","Select",""],["","70377002811","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","25.5","Select","Select",""],["","59310057922","PROAIR ","","25.5","Select","Select",""],["","10370074501","GLIPIZIDE","5MG","180","Select","Select",""],["","57664047758","METOPROL","50MG","90","Select","Select",""],["","00093317431","ALBUTEROL","E","25.5","Select","Select",""],["","59310057922","PROAIR","","25.5","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":[[["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":""}]}]}