{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBORAH A CARMINE","gend":1,"add":"2816 FAIRFIELD AVE","city":"RICHMOND ","state":"VA","zip":"23223-9998","dob":"1953-07-23","age":"","mstatus":"","insh":11011793,"cliId":"8N71CD7KA36","pno":8046176020,"cno":8046176020,"email":"","ename":"","eno":"","pphy":"SHUKLA, ANJALI HEMANT","ppno":8047416200,"pcpadd":"9600 PATTERSON AVENUE","pcpcity":"HENRICO  ","pcpstate":"VA","pcpzip":232296053,"pcpcounty":"HENRICO","pcpid":"P0060015","pcpname":"PATTERSON AVENUE FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"UNIT F","add3":"","madd1":"2816 FAIRFIELD AVE","madd2":"UNIT F","madd3":"","mcity":"RICHMOND ","mstate":"VA","mzip":"23223-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F33.3","F60.3","E11.9","I10","F43.12","Z12.31","Z78.0","M85.80","M85.89","N18.3","E78.5","F31.9","B18.1","Z00.00","E55.9","N18.31","Z12.11","Z71.89","I12.9","Z68.24","Z13.31"],"date":["2021-10-12","2021-10-12","2021-10-26","2021-10-26","2021-10-12","2021-10-26","2021-10-26","2020-02-17","2020-02-17","2020-08-07","2021-10-26","2021-06-28","2021-06-28","2021-10-26","2020-08-07","2021-10-26","2020-12-08","2021-10-26","2021-06-28","2021-10-26","2021-10-26"],"priorHcc":[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":[["","6027731","JANUVIA","TAB 100MG","","Select","Select",""],["","597015330","JARDIANCE","TAB 25MG","","Select","Select",""],["","55111032101","GLIMEPIRIDE","TAB 2MG","","Select","Select",""],["","13107015590","PAROXETINE","TAB 20MG","","Select","Select",""],["","68180021509","LOSARTAN\/HCT","TAB 50-12.5","","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","","Select","Select",""],["","378456105","POT CHLORIDE","TAB 10MEQ ER","","Select","Select",""],["","68382031910","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","99073070827","FREESTYLE","TES LITE","","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","55111032101","GLIMEPIRIDE ","TAB 2MG","180","Select","Select",""],["","597015330","JARDIANCE ","TAB 25MG","90","Select","Select",""],["","6027731","JANUVIA ","TAB 100MG","90","Select","Select",""],["","13107015590","PAROXETINE ","TAB 20MG","90","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","68382031910","TRAMADOL ","TAB 50MG","36","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","200","Select","Select",""],["","68180021509","LOSARTAN\/HCT ","TAB 50-12.5","90","Select","Select",""],["","70377002811","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","70436000203","POT  CHLORIDE","TAB 10MEQ ER","180","Select","Select",""],["","68382075810","METFORMIN ","TAB 500MG","360","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","99073013001","FREESTYLE MIS LANCETS","LANCETS","100","Select","Select",""],["","99073070827","FREESTYLE TES LITE","LITE","200","Select","Select",""],["","68382031910","TRAMADOL","50MG","36","Select","Select",""],["","99073070805","FREESTYLE MIS LITE","LITE","1","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":""}]}]}