{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID J SCHMICK","gend":0,"add":"7202 WINDING CREEK LN","city":"CHESTERFIELD","state":"VA","zip":"23832-9998","dob":"1990-08-17","age":"","mstatus":"","insh":11010275,"cliId":"5FH9V16WP26","pno":8047456090,"cno":8048680730,"email":"","ename":"","eno":"","pphy":"JIMA, BOGALE","ppno":8047390910,"pcpadd":"13861 Hull Street Rd Ste 200","pcpcity":"Midlothian  ","pcpstate":"VA","pcpzip":231122091,"pcpcounty":"","pcpid":"P0113816","pcpname":"PRIMARY HEALTH GROUP INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"7202 WINDING CREEK LN","madd2":"","madd3":"","mcity":"CHESTERFIELD","mstate":"VA","mzip":"23832-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["L72.0","F84.0","E78.5","Z68.25","F70","Z00.00","K59.09","F90.0","Z11.1","H61.23","I10","R00.2","R53.83","R53.81","Z79.899","R00.0"],"date":["2021-02-26","2021-04-13","2021-04-13","2021-08-31","2021-10-18","2021-04-13","2021-04-13","2021-07-19","2021-08-31","2021-08-31","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2021-11-07"],"priorHcc":["","","","",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":[["","228212810","CLONIDINE","TAB 0.2MG","","Select","Select",""],["","10370010150","BUPROPN HCL","TAB 150MG XL","","Select","Select",""],["","43547034106","RISPERIDONE","TAB 1MG","","Select","Select",""],["","59762371809","TRIAZOLAM","TAB 0.25MG","","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","","Select","Select",""],["","49281072010","FLUBLOK QUAD","INJ 2020-21","","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","","Select","Select",""],["","54418425","DEXAMETHASON","TAB 4MG","","Select","Select",""],["","228212810","CLONIDINE ","TAB 0.2MG","90","Select","Select",""],["","10370010150","BUPROPN ","TAB 150MG XL","90","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","20","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","14","Select","Select",""],["","54418425","DEXAMETHASON ","TAB 4MG","5","Select","Select",""],["","59762371809","TRIAZOLAM ","TAB 0.25MG","2","Select","Select",""],["","43547034106","RISPERIDONE ","TAB 1MG","90","Select","Select",""],["","49281072010","FLUBLOK ","INJ 2020-21","0.5","Select","Select",""],["","70436001102","BUPROPN","300MG XL","90","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0.5","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","",""],["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":""}]}]}