{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAURALEE R ROMPON","gend":1,"add":"305 KNOB ST APT 4 ","city":"RICH CREEK  ","state":"VA","zip":"24147-9998","dob":"1953-09-07","age":"","mstatus":"","insh":11011894,"cliId":"4H87GY6YU32","pno":5405772496,"cno":5405772496,"email":"","ename":"","eno":"","pphy":"TURSKI III, JOHN T","ppno":2766884331,"pcpadd":"600 W Ridge Rd","pcpcity":"Wytheville  ","pcpstate":"VA","pcpzip":243821044,"pcpcounty":"","pcpid":"P0060190","pcpname":"BLAND COUNTY MEDICAL CLINIC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"305 KNOB ST APT 4 ","madd2":"","madd3":"","mcity":"RICH CREEK  ","mstate":"VA","mzip":"24147-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M32.9","Z79.899","J02.0","H65.193","R50.9","R05","I51.7","E83.110","F33.1","E55.9","J43.9","M81.0","L98.9","M79.604","C44.719","D48.5","L82.1","E83.119","C44.729","L90.5","D22.72","D22.5","D22.62","D22.61","D22.71","L81.4","Z48.817","E06.3","S69.81XA","X58.XXXA","Y93.9","Y92.9","M25.441","M79.7","Z87.39","F17.210","S60.940A","M79.89","M79.644","H25.813","H10.45","H02.839","I44.4","R94.31","J18.1","R07.9","R53.81","Z11.59","J18.9","Z20.828","R06.02","R91.8","Z12.31","F33.0","Z72.0","Z68.1","Z71.3","Z71.82","Z71.6","D22.39","R42","M89.8X2"],"date":["2021-09-08","2021-10-12","2020-04-01","2020-04-01","2020-04-01","2020-10-09","2021-06-10","2021-11-19","2021-09-13","2021-09-13","2021-06-10","2021-09-13","2020-04-30","2020-04-30","2020-05-07","2020-05-07","2021-03-11","2020-05-15","2020-08-07","2020-09-10","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2020-07-02","2021-09-08","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2021-06-10","2020-10-09","2020-10-09","2020-08-31","2020-08-31","2020-08-31","2021-10-12","2021-04-06","2021-10-12","2020-10-09","2020-10-09","2020-10-09","2020-10-09","2020-10-09","2020-10-09","2020-10-19","2020-10-09","2020-10-09","2020-10-09","2020-11-17","2021-06-10","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-03-11","2021-06-10","2021-06-10"],"priorHcc":["",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":[["","43547026550","GABAPENTIN","CAP 100MG","","Select","Select",""],["","69543013104","ALENDRONATE","TAB 70MG","","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","","Select","Select",""],["","68382009605","HYDROXYCHLOR","TAB 200MG","","Select","Select",""],["","310737220","BUDES\/FORMOT","AER 80-4.5","","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","49281012065","FLUZONE HD","INJ PF 20-21","","Select","Select",""],["","143211205","DOXYCYCL HYC","TAB 100MG","","Select","Select",""],["","781183001","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","69543013104","ALENDRONATE ","TAB 70MG","4","Select","Select",""],["","43547026550","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","68382009605","HYDROXYCHLOR ","TAB 200MG","60","Select","Select",""],["","310737220","BUDES\/FORMOT ","AER 80-4.5","10.2","Select","Select",""],["","143211205","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","0.7","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","30","Select","Select",""],["","781183001","PROMETHAZINE ","25MG","15","Select","Select",""],["","00143211205","DOXYCYCL","100MG","20","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","0.7","Select","Select",""],["","00005197102","PREVNAR","","1","Select","Select",""],["","00005197102","PREVNAR ","INJ ","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":[[["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":""}]}]}