{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BURTON S DILES","gend":0,"add":"2104 PATTERSON RD ","city":"PATTERSON","state":"VA","zip":"24631-9998","dob":"1966-05-22","age":"","mstatus":"","insh":11010890,"cliId":"8A91CG6YU13","pno":2764984286,"cno":"","email":"","ename":"","eno":"","pphy":"CORTELLESI, THOMAS B ","ppno":2769352677,"pcpadd":"ONE CLINIC DRIVE CLAYPOOL HILL","pcpcity":"RICHLANDS","pcpstate":"VA","pcpzip":246411100,"pcpcounty":"TAZEWELL","pcpid":"P9058631","pcpname":"FAMILY CARE CENTER LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2104 PATTERSON RD ","madd2":"","madd3":"","mcity":"PATTERSON","mstate":"VA","mzip":"24631-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M54.5","S14.109A","S09.90XA","R10.2","S49.92XA","S30.0XXA","V49.50XA","S39.93XA","S40.022A","M62.838","M79.671"],"date":["2020-04-11","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-11-08"],"priorHcc":["","","","","","","","","","",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":[["","68180016013","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","","Select","Select",""],["","65162046610","IBUPROFEN","TAB 800MG","","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","55111018015","TIZANIDINE ","TAB 4MG","60","Select","Select",""],["","65162046610","IBUPROFEN ","TAB 800MG","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","",""],["Yes","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":""}]}]}