{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HELEN L ROBERTSON","gend":1,"add":"11603 LITTLE BAY HARB WAY  ","city":"SPOTSYLVANIA","state":"VA","zip":"22551-9998","dob":"1924-01-10","age":"","mstatus":"","insh":11012884,"cliId":"2RH3RP4NK02","pno":5408092708,"cno":5408092708,"email":"","ename":"","eno":"","pphy":"CLEMO, F LYNNE W  ","ppno":5407869771,"pcpadd":"12006 Kilarney Dr","pcpcity":"Fredericksburg ","pcpstate":"VA","pcpzip":224077207,"pcpcounty":"","pcpid":"P0124286","pcpname":"CHANCELLOR INTERNAL MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"11603 LITTLE BAY HARB WAY  ","madd2":"","madd3":"","mcity":"SPOTSYLVANIA","mstate":"VA","mzip":"22551-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F03.90","R39.81","H40.1133","H26.493","H35.3131","H43.393","C79.9","C73","Z71.89","K22.70","R39.89","Z00.00","G30.9","F02.80","R69","F02.81","K21.9","F32.9","E03.9","M15.9","H40.9","H26.9","R32","E66.9","Z68.30"],"date":["2021-10-01","2021-10-05","2021-07-15","2021-07-15","2021-07-15","2020-12-15","2020-12-01","2020-12-01","2020-06-24","2020-06-24","2020-11-18","2020-06-24","2020-12-01","2020-12-01","2021-04-01","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","17478028811","TIMOLOL MAL","SOL 0.5% OP","","Select","Select",""],["","69097084805","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","69238183207","LEVOTHYROXIN","TAB 75MCG","","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","59762033302","LATANOPROST","SOL 0.00005","","Select","Select",""],["","43547034050","RISPERIDONE","TAB 0.5MG","","Select","Select",""],["","49281012065","FLUZONE HD","INJ PF 20-21","","Select","Select",""],["","69097084805","ESCITALOPRAM ","TAB 10MG","90","Select","Select",""],["","69238183207","LEVOTHYROXIN ","TAB 75MCG","85","Select","Select",""],["","17478028811","TIMOLOL ","SOL 0.5% OP","10","Select","Select",""],["","68382050010","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","59762033302","LATANOPROST ","SOL 0.00005","7.5","Select","Select",""],["","43547034050","RISPERIDONE ","TAB 0.5MG","30","Select","Select",""],["","49281012065","FLUZONE ","INJ PF 20-21","0.7","Select","Select",""],["","17478028811","TIMOLOL","0.5% OP","10","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","0.7","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":""}]}]}