{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARTHA POWELL","gend":1,"add":"21200 CHERITON CROSS ROAD  ","city":"CHERITON ","state":"VA","zip":"23316-9998","dob":"1940-07-15","age":"","mstatus":"","insh":11010870,"cliId":"8CP8T37RY38","pno":7573313935,"cno":7573313935,"email":"","ename":"","eno":"","pphy":"BALMORIA, SANDRA K","ppno":7578245676,"pcpadd":"5219 LANKFORD HIGHWAY","pcpcity":"NEW CHURCH  ","pcpstate":"VA","pcpzip":234153332,"pcpcounty":"","pcpid":"P9058368","pcpname":"BAYVIEW COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","aligned":"Y","ano":"","add2":"","add3":"","madd1":"21200 CHERITON CROSS ROAD  ","madd2":"","madd3":"","mcity":"CHERITON ","mstate":"VA","mzip":"23316-9998","region":"TIDEWATER","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","M17.10","Z11.59","G89.29","M47.816","M81.0","J45.909","Z79.51","E78.5","E55.9","E66.9","Z68.37","Z79.82","Z79.83","Z79.899","Z20.828","B34.9","B35.1","Z23","J30.2","I49.9","F41.8","I49.3","M17.11","M25.561","R42","M19.90","R03.0","Z74.3","M51.36","M54.5","J45.20","E66.01","Z68.38","M25.511","Z71.3"],"date":["2021-11-03","2021-04-20","2020-09-03","2021-08-30","2021-09-30","2021-09-30","2021-09-30","2020-10-29","2021-09-30","2021-11-03","2020-10-29","2020-10-29","2021-09-30","2020-10-29","2021-05-14","2021-01-19","2021-01-19","2021-01-19","2021-11-03","2021-11-03","2020-09-03","2020-09-03","2020-09-03","2021-05-12","2021-05-12","2021-05-16","2021-05-14","2021-05-14","2021-05-14","2021-08-30","2021-08-30","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-03"],"priorHcc":[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":[["","67877019910","AMLODIPINE","TAB 10MG","","Select","Select",""],["","16714097601","DICLOFENAC","GEL 0.01","","Select","Select",""],["","16729000517","SIMVASTATIN","TAB 20MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","65862032904","ALENDRONATE","TAB 70MG","","Select","Select",""],["","31722070010","LOSARTAN POT","TAB 25MG","","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","16714097601","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","67877019910","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","31722070010","LOSARTAN ","TAB 25MG","90","Select","Select",""],["","69097022476","ALENDRONATE ","TAB 70MG","12","Select","Select",""],["","16714068303","SIMVASTATIN ","TAB 20MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","173068220","VENTOLIN ","AER ","18","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","31722070010","LOSARTAN","25MG","90","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","68382005001","MELOXICAM","7.5MG","30","Select","Select",""],["","68382005001","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","68382056410","METOPROL ","TAB 25MG ER","90","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":""}]}]}