{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANIEL L BLACKWELL","gend":0,"add":"5108 WHETSTONE RD ","city":"NORTH CHESTERFIELD","state":"VA","zip":"23234-9998","dob":"1990-05-11","age":"","mstatus":"","insh":11011507,"cliId":"3HM1PA2CH14","pno":7573380597,"cno":8045600649,"email":"","ename":"","eno":"","pphy":"REHMAN, SYED A ","ppno":7575362246,"pcpadd":"500 Hioaks Rd,Ste B","pcpcity":"Richmond ","pcpstate":"VA","pcpzip":232254061,"pcpcounty":"","pcpid":"P0114198","pcpname":"PRIMARY HEALTH GROUP INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APARTMENT D","add3":"","madd1":"5108 WHETSTONE RD ","madd2":"APARTMENT D","madd3":"","mcity":"NORTH CHESTERFIELD","mstate":"VA","mzip":"23234-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z02.2","G44.209","R51","R53.1","F70","Z68.34","R10.32","F90.9","F79","R10.9","F43.21","L03.211","R51.9","R22.0","L02.416","M79.89","Z48.01","L02.92","Z68.32","Z20.828","Z00.00","Z68.31"],"date":["2020-04-23","2020-05-27","2020-05-27","2020-05-27","2021-08-24","2020-09-23","2020-10-09","2020-10-09","2020-10-09","2020-10-09","2021-03-31","2020-12-17","2020-12-17","2020-12-17","2021-02-21","2021-02-19","2021-02-21","2021-02-23","2021-02-23","2021-03-25","2021-08-24","2021-08-24"],"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":[["","33332032001","AFLURIA QUAD","INJ 2020-21","","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","42806031250","DOXYCYCL HYC","TAB 100MG","","Select","Select",""],["","33332032001","AFLURIA ","INJ 2020-21","0.5","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","28","Select","Select",""],["","42806031250","DOXYCYCL ","100MG","14","Select","Select",""],["","33332032001","AFLURIA","2020-21","0.5","Select","Select",""],["","42806031250","DOXYCYCL","100MG","14","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":""}]}]}