{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BETTY TOWNSEND","gend":1,"add":"5011 CRYORS LN ","city":"MCKENNEY ","state":"VA","zip":"23872-9998","dob":"1946-11-02","age":"","mstatus":"","insh":11011724,"cliId":"9MX0Q31WV23","pno":4345949672,"cno":4345949672,"email":"","ename":"","eno":"","pphy":"SWAN, DENNIS","ppno":8045912890,"pcpadd":"213 N Main St","pcpcity":"Blackstone  ","pcpstate":"VA","pcpzip":238241425,"pcpcounty":"","pcpid":"P0060028","pcpname":"BLACKSTONE FAMILY PRACTICE CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"5011 CRYORS LN ","madd2":"","madd3":"","mcity":"MCKENNEY ","mstate":"VA","mzip":"23872-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E11.65","I10","N39.46","N18.9","E11.21","G62.9","F34.1","R32","Z68.39","Z12.31","R30.0","E78.00","E83.42","Z00.00","Z13.31","Z23","K21.9","Z68.41","E66.01","M79.604","R60.0","E11.9","Z79.82","Z79.84","M79.651","M16.11","M17.11","M25.561","M25.551","M25.552","M16.0","E11.40","Z79.899","M79.606","R53.81","S99.911A","R26.2","N39.0","R52","M79.609","R53.1","N30.00","S93.401D","M62.81","R29.898","M10.9","I50.9","M25.571","M79.89","M25.471","W18.39XA","Y93.89","Y92.89","Y99.8","S93.401A","Z20.822","B96.20","E78.5","E66.9","W19.XXXA","S90.31XA","M85.871","M19.011"],"date":["2021-08-01","2021-10-31","2021-09-04","2021-09-04","2021-06-29","2021-06-29","2021-06-29","2020-03-06","2020-03-06","2020-08-14","2020-12-11","2021-10-31","2021-06-29","2020-08-14","2020-08-14","2021-10-31","2021-06-29","2021-10-26","2021-06-29","2021-10-17","2021-10-14","2021-11-26","2021-10-26","2021-10-31","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-10-17","2021-10-17","2021-10-17","2021-10-22","2021-10-26","2021-11-26","2021-11-26","2021-11-26","2021-10-17","2021-10-26","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-27","2021-10-27","2021-10-27"],"priorHcc":["",null,"","","","","","","","","",null,"","","",null,"",null,"","","",null,null,null,"","","","","","","","","","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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":[["","2143380","TRULICITY","INJ 0.75\/0.5","","Select","Select",""],["","68645058459","METFORMIN","TAB 1000MG","","Select","Select",""],["","57237001930","DULOXETINE","CAP 60MG","","Select","Select",""],["","6027754","JANUVIA","TAB 100MG","","Select","Select",""],["","93720210","PRAVASTATIN","TAB 40MG","","Select","Select",""],["","68645019059","METOPROL TAR","TAB 50MG","","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","65162018910","NAPROXEN","TAB 375MG","","Select","Select",""],["","2143380","TRULICITY ","INJ 0.75\/0.5","2","Select","Select",""],["","68645058459","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","57237001930","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","6027754","JANUVIA ","TAB 100MG","30","Select","Select",""],["","93720210","PRAVASTATIN ","TAB 40MG","30","Select","Select",""],["","68645019059","METOPROL ","TAB 50MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","43547040211","FUROSEMIDE ","TAB 40MG","90","Select","Select",""],["","65162018910","NAPROXEN ","TAB 375MG","60","Select","Select",""],["","68645019059","METOPROL","50MG","30","Select","Select",""],["","62135030905","CIPROFLOXACN ","TAB 500MG","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}