{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SANDRA L BOLINSKY","gend":1,"add":"752 SW MAY AVE ","city":"COEBURN  ","state":"VA","zip":"24230-9998","dob":"1974-01-16","age":"","mstatus":"","insh":11013324,"cliId":"7TE9GW2MQ34","pno":2768709704,"cno":2768709704,"email":"","ename":"","eno":"","pphy":"RENFRO, THOMAS E  ","ppno":2767622300,"pcpadd":"16431 Wise St","pcpcity":"Saint Paul  ","pcpstate":"VA","pcpzip":242833537,"pcpcounty":"","pcpid":"P9058555","pcpname":"COMMUNITY PHYSICIANS COEBURN","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"752 SW MAY AVE ","madd2":"","madd3":"","mcity":"COEBURN  ","mstate":"VA","mzip":"24230-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["G51.8","M79.10","G51.32","G51.39","K21.9","F32.9","F41.1","D32.0","M51.36","D50.9","Z87.891","Z79.82","K08.409","Z68.25","Z01.419","D25.1","N64.4","N64.52","N92.0","Z11.51","R10.31","R10.30","R11.0","R10.9","D32.9","M79.2","M62.838","R51.0","R51.9","Z01.818","Z20.822","I49.8","I45.10","R94.31","Z01.810","Z01.812","Z01.811","G93.6","D62","R47.01","R29.810","I49.3","F41.9","F32.A","Z45.2","R93.0"],"date":["2021-09-09","2020-10-08","2021-10-27","2020-07-24","2021-11-02","2020-07-24","2020-07-24","2021-11-02","2020-07-24","2020-07-24","2021-04-15","2020-07-24","2020-07-24","2020-07-24","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-11-12","2021-11-12","2021-11-12","2021-09-16","2021-11-12","2021-10-30","2021-10-30","2021-11-03","2021-11-03","2021-11-03","2021-10-26","2021-10-25","2021-10-25","2021-11-03","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02"],"priorHcc":["","","","",null,"","",null,"","","","","","","","","","","","","","","","",null,null,null,"",null,"","",null,null,null,null,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":[["","15054053006","DYSPORT","INJ 300UNIT","","Select","Select",""],["","31722053301","METHOCARBAM","TAB 500MG","","Select","Select",""],["","15054053006","DYSPORT ","INJ 300UNIT","1","Select","Select",""],["","31722053301","METHOCARBAM ","TAB 500MG","12","Select","Select",""],["","66689000816","NYSTATIN ","SUS 100000","60","Select","Select",""],["","68180011416","LEVETIRACETA ","TAB 750MG","60","Select","Select",""],["","59746012206","MECLIZINE ","TAB 12.5MG","42","Select","Select",""],["","00406012505","HYDROCO\/APAP ","TAB 10-325MG","50","Select","Select",""],["","42195095510","BUT\/APAP\/CAF ","CAP ","56","Select","Select",""],["","65862044990","VALACYCLOVIR ","TAB 1GM","10","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":""}]}]}