{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PERCY REED","gend":0,"add":"16303FIVE FORKS  ROAD","city":"AMELIA","state":"VA","zip":"23002-2728","dob":"1975-10-12","age":"","mstatus":"","insh":11011981,"cliId":"1W94V74RF82","pno":4342940685,"cno":4342940685,"email":"","ename":"","eno":"","pphy":"SEQUEIRA, DEBRA M ","ppno":8045615150,"pcpadd":"702 N Main St","pcpcity":"Emporia  ","pcpstate":"VA","pcpzip":238471242,"pcpcounty":"","pcpid":"P9058334","pcpname":"AMELIA HEALTH CARE CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"PO BOX 165  ","add3":"","madd1":"16303FIVE FORKS  ROAD","madd2":"PO BOX 165  ","madd3":"","mcity":"AMELIA","mstate":"VA","mzip":"23002-2728","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R10.31","K40.90","Z68.41","R10.2","Z01.812","Z11.59","E66.01","F17.210","Z79.899","E55.9","Z12.5","E78.5","R53.83","E66.8","N39.0","J45.30","Z12.11"],"date":["2020-05-15","2020-05-27","2021-03-05","2020-05-15","2020-05-23","2020-05-23","2020-05-27","2020-05-27","2020-05-27","2021-11-17","2021-03-05","2021-03-05","2021-03-05","2021-03-05","2021-11-17","2021-11-17","2021-11-17"],"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":[["","487950125","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","378932132","WIXELA INHUB","AER 250\/50","","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","","Select","Select",""],["","173069600","ADVAIR DISKU","AER 250\/50","","Select","Select",""],["","13668008190","MONTELUKAST","TAB 10MG","","Select","Select",""],["","53746010905","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","66993058597","FLUTIC\/SALME ","AER 250\/50","60","Select","Select",""],["","487950125","ALBUTEROL ","NEB 0.00083","300","Select","Select",""],["","378932132","WIXELA ","AER 250\/50","60","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","13668008190","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","53746010905","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","00378932132","WIXELA","250\/50","60","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":""}]}]}