{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANNIE C FARRELL","gend":1,"add":"5753 PENN LAIRD DR","city":"PENN LAIRD  ","state":"VA","zip":"22846-9998","dob":"1987-10-24","age":"","mstatus":"","insh":11012780,"cliId":"4FU3WN9VP15","pno":5402693082,"cno":5402693082,"email":"","ename":"","eno":"","pphy":"BUCKWALTER, VICTOR LEE  ","ppno":5404334913,"pcpadd":"1151 Keezletown Rd Ste 101","pcpcity":"Weyers Cave ","pcpstate":"VA","pcpzip":244862337,"pcpcounty":"","pcpid":"P0117820","pcpname":"CARILION FAMILY MEDICINE WEYERS CAVE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"5753 PENN LAIRD DR","madd2":"","madd3":"","mcity":"PENN LAIRD  ","mstate":"VA","mzip":"22846-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["G80.8","G40.401","R63.3","G40.909","G80.9","R39.81","R62.50","M41.20","Z93.4","Z23","R13.10","J69.0","G80.3","G40.309","Z93.1","Z68.21","Z46.59","Z43.4","Z68.1","Q65.89","J18.9","A41.9","G80.0","F72","M41.9","Z20.822","Z99.3","Z87.01","Z90.5","Z82.49","Z79.899","Z88.1","Z88.8","R00.0","J98.6","R07.9","J18.1","R06.02","R63.39","I51.7"],"date":["2021-08-04","2021-04-20","2021-05-17","2021-07-23","2021-11-06","2021-11-06","2021-11-06","2021-06-01","2021-08-04","2021-09-21","2021-10-15","2021-10-15","2021-10-15","2021-01-15","2021-07-23","2020-08-28","2020-11-25","2021-11-20","2020-08-28","2021-06-01","2021-08-04","2021-07-23","2021-07-23","2021-07-23","2021-07-18","2021-07-18","2021-07-18","2021-07-18","2021-07-18","2021-07-18","2021-07-18","2021-07-18","2021-07-18","2021-07-21","2021-07-18","2021-07-18","2021-07-21","2021-07-21","2021-10-21","2021-07-23"],"priorHcc":["","","","",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":[["","60432062116","VALPROIC ACD","SOL 250\/5ML","","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","","Select","Select",""],["","116200116","CHLORHEX GLU","SOL 0.0012","","Select","Select",""],["","60432062116","VALPROIC ","SOL 250\/5ML","900","Select","Select",""],["","45802046564","KETOCONAZOLE ","SHA 0.02","240","Select","Select",""],["","116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","60432062116","VALPROIC","250\/5ML","900","Select","Select",""],["","60432006500","AMOX\/K","250\/5ML","100","Select","Select",""],["","00116200116","CHLORHEX","0.0012","473","Select","Select",""],["","60432006500","AMOX\/K ","SUS 250\/5ML","100","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":""}]}]}