{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOAN M COVERT","gend":1,"add":"5300 BUCKSKIN CREEK ROAD","city":"JETERSVILLE ","state":"VA","zip":"23083-9998","dob":"1952-11-13","age":"","mstatus":"","insh":11011654,"cliId":"2HJ6U25MU81","pno":4346071150,"cno":4346017750,"email":"","ename":"","eno":"","pphy":"HOLLAND, JOHN A","ppno":4346962165,"pcpadd":"1508 K V Rd","pcpcity":"Victoria ","pcpstate":"VA","pcpzip":239742624,"pcpcounty":"","pcpid":"P9058797","pcpname":"LUNENBURG MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"5300 BUCKSKIN CREEK ROAD","madd2":"","madd3":"","mcity":"JETERSVILLE ","mstate":"VA","mzip":"23083-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["D48.5","L82.1","D22.5","Z85.828","D17.1","D17.22","L57.0","Z00.00","R79.0","L81.4","L57.8","X32.XXXD","D22.9","Z12.83","R06.00","R06.02"],"date":["2020-11-19","2021-11-18","2021-05-20","2021-11-18","2021-01-08","2021-01-08","2021-07-09","2021-09-29","2021-09-29","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-10","2021-11-10"],"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":[["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","60505006501","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","62332004060","LAMOTRIGINE","TAB 200MG","","Select","Select",""],["","93831018","ELETRIPTAN","TAB 20MG","","Select","Select",""],["","60505252703","MODAFINIL","TAB 200MG","","Select","Select",""],["","59746033090","DONEPEZIL","TAB 10MG","","Select","Select",""],["","59310058020","PROAIR RESPI","AER ","","Select","Select",""],["","43547027609","DONEPEZIL ","TAB 10MG","135","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","17","Select","Select",""],["","60505006501","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","42043016103","MODAFINIL ","TAB 200MG","90","Select","Select",""],["","62332004060","LAMOTRIGINE ","TAB 200MG","15","Select","Select",""],["","93831018","ELETRIPTAN ","TAB 20MG","10","Select","Select",""],["","59310058020","PROAIR ","AER ","1","Select","Select",""],["","00093317431","ALBUTEROL","E","17","Select","Select",""],["","59310058020","PROAIR","","1","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","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":""}]}]}