{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VIRGINIA J SURRETT","gend":1,"add":"9320 HERITAGE RD  ","city":"WISE  ","state":"VA","zip":"24293-9998","dob":"1971-02-03","age":"","mstatus":"","insh":11011898,"cliId":"4G91M04DG03","pno":2768703530,"cno":2768703530,"email":"","ename":"","eno":"","pphy":"HARMAN, DEREK C","ppno":2766790321,"pcpadd":"295 Wharton Ln NE","pcpcity":"Norton","pcpstate":"VA","pcpzip":242731541,"pcpcounty":"","pcpid":"P9059237","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 4232 ","madd2":"","madd3":"","mcity":"WISE  ","mstate":"VA","mzip":"24293-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E11.42","Z79.84","E11.9","K59.00","Z76.0","G62.9","E55.9","Z85.42","Q90.9","K59.03","M62.81","E11.40","K64.4","M19.91","M81.0","E66.01","R32","Z68.43","Z91.81","E03.9","E53.9","C56.9","C54.1","K64.9","K08.109","Z87.311","B37.3","J30.2","N39.0","A49.9","B37.9","R39.89","R31.9"],"date":["2020-05-26","2020-11-01","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2020-11-01","2020-11-01","2020-07-28","2020-11-01","2020-11-01","2020-11-01","2020-11-01","2020-11-01","2020-11-01","2020-11-01","2020-11-01","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-05-26","2020-05-26","2020-05-26","2021-03-11","2021-03-11","2021-09-09","2021-04-27","2021-11-19","2021-10-20","2021-11-16"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","45802005911","NYSTATIN","CRE 100000","","Select","Select",""],["","67877022410","GABAPENTIN","CAP 400MG","","Select","Select",""],["","6027731","JANUVIA","TAB 100MG","","Select","Select",""],["","69097022416","ALENDRONATE","TAB 70MG","","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","23155010210","METFORMIN","TAB 500MG","","Select","Select",""],["","47781064390","LEVOTHYROXIN","TAB 50MCG","","Select","Select",""],["","16729003515","ANASTROZOLE","TAB 1MG","","Select","Select",""],["","574200802","NYSTOP","POW 100000","","Select","Select",""],["","68462010340","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","67877022410","GABAPENTIN ","CAP 400MG","90","Select","Select",""],["","45802005911","NYSTATIN ","CRE 100000","30","Select","Select",""],["","65162027250","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","185012201","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","68462010340","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","6011231","JANUVIA ","TAB 50MG","30","Select","Select",""],["","47781064390","LEVOTHYROXIN ","TAB 50MCG","30","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","69097022416","ALENDRONATE ","TAB 70MG","4","Select","Select",""],["","574200802","NYSTOP ","POW 100000","60","Select","Select",""],["","23155010210","METFORMIN ","TAB 500MG","180","Select","Select",""],["","16729003515","ANASTROZOLE ","TAB 1MG","30","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","20","Select","Select",""],["","00185012201","NITROFURANTN","100MG","10","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","28","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","28","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":""}]}]}