{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WINSTON MARTIN","gend":0,"add":"1642COAKLEY TOWN RD  ","city":"DAYTON","state":"VA","zip":"22821-9998","dob":"1994-07-11","age":"","mstatus":"","insh":11011668,"cliId":"5RC3VX5VK88","pno":5404215296,"cno":5404215296,"email":"","ename":"","eno":"","pphy":"PENCE, ROBERT P","ppno":5408792585,"pcpadd":"15 Killdeer Ln","pcpcity":"Dayton","pcpstate":"VA","pcpzip":228219745,"pcpcounty":"","pcpid":"P0117891","pcpname":"CARILION FAMILY MEDICINE DAYTON","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1642COAKLEY TOWN RD  ","madd2":"","madd3":"","mcity":"DAYTON","mstate":"VA","mzip":"22821-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F84.0","F80.2","F63.81","F39","R63.4","Z00.00","J34.89","B35.1","F41.9","Z11.1","Z11.59","Z20.828","R63.6","R47.82","Z51.81","R79.9","Z13.1","L74.513"],"date":["2021-10-28","2020-09-15","2021-10-28","2021-10-28","2021-04-26","2020-09-04","2020-09-04","2021-10-26","2021-10-28","2020-09-23","2020-10-26","2020-10-26","2021-04-26","2021-04-26","2021-10-28","2021-08-17","2021-03-19","2021-08-16"],"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":[["","45802014167","CICLOPIROX","SOL 0.08","","Select","Select",""],["","65862037505","ESCITALOPRAM","TAB 20MG","","Select","Select",""],["","27241000150","RISPERIDONE","TAB 1MG","","Select","Select",""],["","228202950","ALPRAZOLAM","TAB 0.5MG","","Select","Select",""],["","27241000150","RISPERIDONE ","TAB 1MG","28","Select","Select",""],["","45802014167","CICLOPIROX ","SOL 0.08","6.6","Select","Select",""],["","13668013701","ESCITALOPRAM ","TAB 20MG","90","Select","Select",""],["","228202950","ALPRAZOLAM ","TAB 0.5MG","15","Select","Select",""],["","51991052633","TERBINAFINE","250MG","19","Select","Select",""],["","51991052633","TERBINAFINE ","TAB 250MG","26","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":""}]}]}