{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHIRLEY EDMUNDS","gend":1,"add":"113 MYRTLE STREET ","city":"SOUTH BOSTON","state":"VA","zip":"24592-3532","dob":"1964-07-20","age":"","mstatus":"","insh":11012896,"cliId":"8NR6GR1VR84","pno":4342229296,"cno":9142681202,"email":"","ename":"","eno":"","pphy":"ARTHUR, MELISSA P P  ","ppno":"               ","pcpadd":"2232 WILBORN AVENUE","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":245921662,"pcpcounty":"","pcpid":"P0060083","pcpname":"HALIFAX PRIMARY CARE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"113 MYRTLE STREET ","madd2":"","madd3":"","mcity":"SOUTH BOSTON","mstate":"VA","mzip":"24592-3532","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F10.97","I10","I63.9","R26.9","F10.27","E03.9","R73.03","Z23"],"date":["2020-08-24","2021-11-25","2021-11-25","2021-11-25","2021-11-25","2020-10-09","2020-10-09","2020-10-09"],"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":[["","378180010","LEVOTHYROXIN","TAB 25MCG","","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","","Select","Select",""],["","68645057054","CITALOPRAM","TAB 20MG","","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","378180010","LEVOTHYROXIN ","TAB 25MCG","15","Select","Select",""],["","68645051554","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","68645057054","CITALOPRAM ","TAB 20MG","90","Select","Select",""],["","68645014059","FAMOTIDINE ","TAB 20MG","180","Select","Select",""],["","68645019059","METOPROL ","50MG","90","Select","Select",""],["","68645019059","METOPROL","50MG","90","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":""}]}]}