{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HUNTER E LOY","gend":0,"add":"157 CALDWELL LANE ","city":"WINCHESTER  ","state":"VA","zip":"22602-9998","dob":"1954-04-09","age":"","mstatus":"","insh":11010588,"cliId":"4WY8PH4DR51","pno":5403134403,"cno":5403134403,"email":"","ename":"","eno":"","pphy":"BYRD, JESSICA  ","ppno":5406780792,"pcpadd":"2913 Valley Ave Ste 200","pcpcity":"Winchester  ","pcpstate":"VA","pcpzip":226012678,"pcpcounty":"","pcpid":"P9058341","pcpname":"APPLE BLOSSOM FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"157 CALDWELL LANE ","madd2":"","madd3":"","mcity":"WINCHESTER  ","mstate":"VA","mzip":"22602-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R69","E78.2","I10","Z68.39","R05","R50.9","K40.90","K45.8","Z71.3","J44.9","N48.89","N48.1","R74.8","R06.02","E78.5","N18.3","N47.1","N20.0","N17.9","N39.0","Z12.5","N43.3","B96.20","R10.30","R29.6","S49.91XA","S38.02XA","Z00.00","T81.41XA","R82.71","G89.29","N50.82","H25.813","H25.812","H25.811","I49.9","H61.22","R73.01","H26.9","S89.91XA"],"date":["2020-08-10","2021-11-01","2021-11-29","2021-11-29","2020-03-10","2020-03-10","2020-03-30","2020-03-30","2021-11-29","2020-08-04","2021-08-27","2020-12-07","2020-08-04","2020-08-04","2021-10-21","2020-08-10","2021-06-14","2021-04-07","2020-12-23","2021-04-29","2020-12-07","2021-08-27","2021-03-01","2021-03-01","2021-03-17","2021-03-17","2021-03-17","2021-04-07","2021-05-04","2021-06-14","2021-08-27","2021-08-27","2021-08-31","2021-10-14","2021-10-21","2021-11-01","2021-11-01","2021-11-01","2021-10-21","2021-11-29"],"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":[["","55111014512","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","68462029817","CLOTRIM\/BETA","CRE DIPROP","","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","","Select","Select",""],["","68645049554","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","45802008801","ALBUTEROL","AER HFA","","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","143992701","CIPROFLOXACN","TAB 250MG","","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","31722063231","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","","Select","Select",""],["","68645051654","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","68645049554","ATORVASTATIN ","TAB 80MG","90","Select","Select",""],["","55111014512","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","45802008801","ALBUTEROL ","AER HFA","8.5","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","10","Select","Select",""],["","68462029817","CLOTRIM\/BETA ","CRE DIPROP","15","Select","Select",""],["","31722063231","OSELTAMIVIR ","CAP 75MG","10","Select","Select",""],["","65162027250","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","93101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","143992701","CIPROFLOXACN ","TAB 250MG","6","Select","Select",""],["","68645051054","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","00093101042","MUPIROCIN","0.02","22","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","14","Select","Select",""],["","60758011905","PREDNISOLONE","1% OP","10","Select","Select",""],["","24208044605","BESIVANCE","0.60%","5","Select","Select",""],["","70461012103","FLUAD ","INJ 2021-22","0.5","Select","Select",""],["","24208044605","BESIVANCE ","SUS 0.006","5","Select","Select",""],["","60758011905","PREDNISOLONE ","SUS 1% OP","10","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","",false,""],["No","Select","",false,""],["Yes","Select","",false,""],["Yes","Select","",false,""],["No","Select","",false,""],["No","Select","",false,""],["N\/A","Select","",false,""]]]},{"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":""}]}]}