{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MATTHEW J HOLLEN","gend":0,"add":"6006JOHNSON'S CREEK ROAD","city":"COVINGTON","state":"VA","zip":"24426-5237","dob":"1974-09-12","age":"","mstatus":"","insh":11011271,"cliId":"5UK0MF5VF11","pno":2607051398,"cno":5409686826,"email":"","ename":"","eno":"","pphy":"MONROE, JULIE A","ppno":5404633381,"pcpadd":"55 Comfort Way,Ste 1","pcpcity":"Lexington","pcpstate":"VA","pcpzip":244503788,"pcpcounty":"","pcpid":"P9443176","pcpname":"BATH COMMUNITY PHYSICIANS GROUP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"6006JOHNSON'S CREEK ROAD","madd2":"","madd3":"","mcity":"COVINGTON","mstate":"VA","mzip":"24426-5237","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["G56.02","F17.210","Z01.810","R94.31","L65.9","L63.9","S41.111A","W01.0XXA","W01.198A","Y92.89","Y99.0","F17.200","Z23","Z48.03","T14.8XXA","L08.9","M79.89","W57.XXXA","S60.511A"],"date":["2020-02-11","2020-02-04","2020-02-04","2020-02-04","2020-05-20","2020-06-23","2020-09-13","2020-09-13","2020-09-13","2020-09-13","2020-09-13","2021-08-12","2020-09-13","2020-09-22","2020-09-22","2020-09-22","2021-08-12","2021-08-12","2021-08-12"],"priorHcc":["","","","","","","","","","","","","","","","","","",""]}},{"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":[["","43386002606","FLUOCINONIDE","SOL 0.0005","","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","93101042","MUPIROCIN","OIN 0.02","","Select","Select",""],["","143924920","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","61314054701","LATANOPROST","SOL 0.00005","","Select","Select",""],["","143924920","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","43386002606","FLUOCINONIDE ","SOL 0.0005","60","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","61314054701","LATANOPROST ","SOL 0.00005","2.5","Select","Select",""],["","93101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","59746017509","PREDNISONE","20MG","6","Select","Select",""],["","00093598627","EPINEPHRINE","0.3MG","2","Select","Select",""],["","00143924920","AMOX\/K","875-125","14","Select","Select",""],["","00093598627","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","6","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":""}]}]}