{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AUTUMN A DAVIS","gend":1,"add":"5026 GRAPEFIELD RD","city":"BASTIAN  ","state":"VA","zip":"24314-9998","dob":"1998-09-04","age":"","mstatus":"","insh":11012955,"cliId":"9J95JH0DK56","pno":3049108103,"cno":3049108103,"email":"","ename":"","eno":"","pphy":"QAZI, NAEEM A  ","ppno":"               ","pcpadd":"15 Westwood Medical Park","pcpcity":"Bluefield","pcpstate":"VA","pcpzip":246052000,"pcpcounty":"","pcpid":"P0124242","pcpname":"NAEEM QAZI MD","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"5026 GRAPEFIELD RD","madd2":"","madd3":"","mcity":"BASTIAN  ","mstate":"VA","mzip":"24314-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R30.0","Z71.3","Z71.82","Z68.41","N39.0","K62.5","Z68.43","R19.7","K92.1","K59.00","R10.84","Z01.818","Z11.59","R10.9","R19.4","Z83.79","Z80.0","J45.909","F84.0","E66.9","I10","Z79.82","K21.9","E03.8","E06.3","E04.0","Z83.3","D51.0","E55.9","J30.89","J45.30","N92.6","Z87.42","K21.0","Z01.419","Z12.4","R10.11","E03.9","N10","R07.89","J06.9","Z20.822","N12","Z88.1","Z88.0","Z79.899","E07.9","K76.0","R05","Z88.2","Z88.8","M62.838","R07.9","Q03.9","D72.820","R79.89","D64.9","R68.89","R10.13"],"date":["2021-07-22","2020-06-24","2020-06-24","2020-06-09","2021-07-31","2020-06-24","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2021-07-27","2020-08-13","2020-08-13","2021-07-31","2020-08-18","2020-08-18","2020-08-18","2021-10-21","2021-10-21","2020-08-18","2020-08-18","2020-08-18","2021-08-09","2021-11-16","2021-11-16","2021-11-16","2021-05-14","2021-11-16","2021-11-16","2021-07-21","2021-07-21","2021-07-22","2021-03-25","2021-07-21","2021-07-22","2021-07-22","2021-10-26","2021-10-21","2021-07-31","2021-08-09","2021-08-09","2021-08-09","2021-07-31","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-11-18","2021-08-09","2021-08-09","2021-08-09","2021-07-07","2021-08-10","2021-10-21","2021-10-21","2021-10-21","2021-11-16","2021-11-16","2021-11-18"],"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":[["","62175013637","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","29300022010","MONTELUKAST","TAB 10MG","","Select","Select",""],["","16714043901","NITROFURANTN","CAP 100MG","","Select","Select",""],["","378162005","DICYCLOMINE","TAB 20MG","","Select","Select",""],["","168008031","HYDROCORT","CRE 0.025","","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","74518290","SYNTHROID","TAB 75MCG","","Select","Select",""],["","68382009716","PAROXETINE","TAB 10MG","","Select","Select",""],["","555077902","MEDROXYPR AC","TAB 10MG","","Select","Select",""],["","168009960","KETOCONAZOLE","CRE 0.02","","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","","Select","Select",""],["","16714065202","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","555901658","SPRINTEC 28","TAB 28 DAY","","Select","Select",""],["","29300022010","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","62175013637","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","16714043901","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","378162005","DICYCLOMINE ","TAB 20MG","90","Select","Select",""],["","378180510","LEVOTHYROXIN ","TAB 75MCG","90","Select","Select",""],["","74518290","SYNTHROID ","TAB 75MCG","90","Select","Select",""],["","168008031","HYDROCORT ","CRE 0.025","60","Select","Select",""],["","55111014512","FLUCONAZOLE ","TAB 150MG","3","Select","Select",""],["","10572010001","PEG-3350 ","SOL ELECTROL","4,000.00","Select","Select",""],["","16714065202","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","68382009716","PAROXETINE ","TAB 10MG","30","Select","Select",""],["","168009960","KETOCONAZOLE ","2%","60","Select","Select",""],["","555077902","MEDROXYPR ","10MG","10","Select","Select",""],["","555901658","SPRINTEC ","28 DAY","28","Select","Select",""],["","00378180510","LEVOTHYROXIN","75MCG","90","Select","Select",""],["","70954006020","PREDNISONE","20MG","10","Select","Select",""],["","71930002012","HYDROCO\/APAP","7.5-325","10","Select","Select",""],["","00555900867","NORTREL","0.5\/35","28","Select","Select",""],["","00555077902","MEDROXYPR","10MG","10","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","00555901658","SPRINTEC","28 DAY","28","Select","Select",""],["","51862089203","NECON","0.5\/35","84","Select","Select",""],["","70954006020","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","51862089203","NECON ","TAB 0.5\/35","84","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00555900867","NORTREL ","TAB 0.5\/35","28","Select","Select",""],["","71930002012","HYDROCO\/APAP ","TAB 7.5-325","10","Select","Select",""],["","59651036105","IBUPROFEN ","TAB 600MG","28","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":""}]}]}