{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BENJAMIN DAULTON","gend":0,"add":"152 LONG MEADOWS LN  ","city":"MIDDLETOWN  ","state":"VA","zip":"22645-9998","dob":"1990-04-04","age":"","mstatus":"","insh":11010817,"cliId":"9N96CT4HW84","pno":7575181819,"cno":7575131819,"email":"","ename":"","eno":"","pphy":"GRANT, JOEL T  ","ppno":5408684100,"pcpadd":"160 Warrior Dr","pcpcity":"Stephens City  ","pcpstate":"VA","pcpzip":226554044,"pcpcounty":"","pcpid":"P9059087","pcpname":"STEPHENS CITY FAMILY MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"152 LONG MEADOWS LN  ","madd2":"","madd3":"","mcity":"MIDDLETOWN  ","mstate":"VA","mzip":"22645-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I89.0","Q90.9","C77.4","R59.0","F72","I05.9","I87.2","I10","I27.20","J32.9","H10.9","G47.33","F63.9","H10.32","Q21.2","L08.9","Z00.01","E66.9","M1A.00X0","E03.9","Z20.828","R51.9","J02.9","R50.9","R68.83","M79.10","R06.02","U07.1","J12.82","E78.5","E11.9","R09.02","N17.9","Z68.43","I95.9","E86.0","E87.6","E66.01","Q24.9","Z28.3","N39.46","G47.30","I11.9","F31.9","M10.9","Z95.4","I27.0","Z79.82","Z68.42","R05","Z95.2","R73.01","R60.0","I83.91","Z79.01","F39","S81.809S","Z72.4","Z71.3","L97.919","M25.551","M25.562","M79.662"],"date":["2020-06-10","2021-08-19","2020-01-10","2020-01-10","2021-08-03","2020-02-03","2021-05-20","2021-08-19","2021-06-24","2020-02-22","2020-02-22","2021-10-21","2021-05-04","2020-05-09","2021-11-29","2020-12-30","2021-03-04","2021-08-19","2021-08-19","2021-08-19","2021-08-30","2021-05-12","2021-11-23","2021-05-12","2021-05-12","2021-05-12","2021-05-20","2021-10-21","2021-05-21","2021-06-24","2021-05-20","2021-08-19","2021-05-20","2021-05-20","2021-05-20","2021-05-20","2021-05-20","2021-11-26","2021-05-20","2021-05-20","2020-09-14","2020-09-14","2020-09-14","2020-09-14","2020-09-14","2020-09-14","2020-09-14","2020-09-14","2021-11-26","2021-05-26","2021-11-29","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-07-19","2021-10-07","2021-11-26","2021-07-19","2021-11-09","2021-11-09","2021-11-08"],"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":[["","65162035109","SILDENAFIL","TAB 20MG","","Select","Select",""],["","68382009505","CARVEDILOL","TAB 25MG","","Select","Select",""],["","59746021601","SPIRONOLACT","TAB 25MG","","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","61314062810","POLYMYXIN B\/","SOL TRIMETHP","","Select","Select",""],["","16714004211","ALLOPURINOL","TAB 300MG","","Select","Select",""],["","57237012301","WARFARIN","TAB 4MG","","Select","Select",""],["","72305005030","EUTHYROX","TAB 50MCG","","Select","Select",""],["","781518192","LEVOTHYROXIN","TAB 50MCG","","Select","Select",""],["","13668021730","ARIPIPRAZOLE","TAB 5MG","","Select","Select",""],["","143924920","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","116200116","CHLORHEX GLU","SOL 0.0012","","Select","Select",""],["","69238110002","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","72205002790","ROSUVASTATIN","TAB 5MG","","Select","Select",""],["","65162035109","SILDENAFIL ","TAB 20MG","90","Select","Select",""],["","59746021601","SPIRONOLACT ","TAB 25MG","90","Select","Select",""],["","68382009505","CARVEDILOL ","TAB 25MG","60","Select","Select",""],["","43547040211","FUROSEMIDE ","TAB 40MG","180","Select","Select",""],["","16714004211","ALLOPURINOL ","TAB 300MG","30","Select","Select",""],["","72305005030","EUTHYROX ","TAB 50MCG","30","Select","Select",""],["","61314062810","POLYMYXIN ","SOL TRIMETHP","10","Select","Select",""],["","57237012401","WARFARIN ","TAB 5MG","30","Select","Select",""],["","13668021630","ARIPIPRAZOLE ","TAB 2MG","30","Select","Select",""],["","781518192","LEVOTHYROXIN ","TAB 50MCG","30","Select","Select",""],["","69238110002","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","143924920","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","72205002790","ROSUVASTATIN ","TAB 5MG","90","Select","Select",""],["","54418625","DEXAMETHASON ","6MG","4","Select","Select",""],["","00574200802","NYSTOP ","100000","60","Select","Select",""],["","61314062810","POLYMYXIN","TRIMETHP","10","Select","Select",""],["","69238110002","DOXYCYCL","100MG","20","Select","Select",""],["","00143924920","AMOX\/K","875-125","14","Select","Select",""],["","00116200116","CHLORHEX","0.0012","473","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","20","Select","Select",""],["","00054418625","DEXAMETHASON","6MG","4","Select","Select",""],["","00574200802","NYSTOP","100000","60","Select","Select",""],["","65162027250","SMZ\/TMP ","TAB 800-160","20","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","",""],["No","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":""}]}]}