{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROLYN HALSEY","gend":1,"add":"1155 MEADOWS RD.  ","city":"RAVEN ","state":"VA","zip":"24639-9998","dob":"1968-11-27","age":"","mstatus":"","insh":11012378,"cliId":"4WX1M87MP18","pno":2764980127,"cno":5407598025,"email":"","ename":"","eno":"","pphy":"MULJIBHAI J THAKKAR MD  ","ppno":2769646649,"pcpadd":"3150 Clinch St","pcpcity":"RICHLANDS","pcpstate":"VA","pcpzip":246412172,"pcpcounty":"","pcpid":"P9058896","pcpname":"MULJIBHAI J THAKKAR MD","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 426  ","madd2":"","madd3":"","mcity":"OAKWOOD  ","mstate":"VA","mzip":"24631-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E53.8","E78.5","G62.9","E55.9","M25.561","M25.562","J44.9","M17.0","M79.7","Z23","Z72.0","Z71.6","R10.13","J01.90","J20.9","M54.5","G89.29","F41.8","R06.2","Z20.822","R06.02","R05","R09.89","R07.81","Z87.01","R10.12","J40","J30.1","R14.0","R59.1","R11.0","J44.1","J02.0","J02.9","J06.9","R05.9","R50.9","R09.81","F17.210","M27.8","B96.89"],"date":["2020-07-20","2020-10-27","2020-07-20","2020-10-27","2021-02-26","2021-02-26","2021-11-17","2021-02-26","2020-10-27","2021-11-23","2021-07-06","2021-02-26","2020-10-30","2021-11-23","2020-11-09","2021-02-26","2021-02-26","2021-02-26","2021-05-03","2021-11-17","2021-05-03","2021-05-03","2021-03-24","2021-05-03","2021-05-03","2021-07-06","2021-07-20","2021-07-20","2021-07-06","2021-07-06","2021-07-06","2021-05-17","2021-09-17","2021-09-17","2021-11-17","2021-11-17","2021-11-17","2021-11-17","2021-11-17","2021-11-17","2021-11-23"],"priorHcc":["","","","","","",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":[["","68382005001","MELOXICAM","TAB 7.5MG","","Select","Select",""],["","16714085201","METOPROL SUC","TAB 25MG ER","","Select","Select",""],["","57237001990","DULOXETINE","CAP 60MG","","Select","Select",""],["","16714087601","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","10702001150","HYDROXYZ HCL","TAB 25MG","","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","62175013643","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","13107003134","MIRTAZAPINE","TAB 15MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","","Select","Select",""],["","59762219803","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","54001825","PREDNISONE","TAB 20MG","","Select","Select",""],["","68382005001","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","16714085201","METOPROL ","TAB 25MG ER","30","Select","Select",""],["","57237001990","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","16714087601","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","378064205","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","62175013643","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","60432026415","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","13107003134","MIRTAZAPINE ","TAB 15MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","173071820","FLOVENT ","44MCG","10.6","Select","Select",""],["","173068220","VENTOLIN ","","18","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","28","Select","Select",""],["","16714085201","METOPROL","25MG ER","30","Select","Select",""],["","68462010530","ONDANSETRON","4MG","28","Select","Select",""],["","10702001150","HYDROXYZ","25MG","60","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","00173071820","FLOVENT","44MCG","10.6","Select","Select",""],["","24208039915","IPRATROPIUM","0.0006","15","Select","Select",""],["","53489011905","DOXYCYCL","100MG","14","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","21","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","24208039915","IPRATROPIUM ","SPR 0.0006","15","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":""}]}]}