{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GINA BUCHANAN","gend":1,"add":"224 SURREY CLUB LN","city":"STEPHENS CITY  ","state":"VA","zip":"22655-9998","dob":"1992-08-20","age":"","mstatus":"","insh":11013333,"cliId":"7NJ6X36AQ88","pno":5408682125,"cno":5408682125,"email":"","ename":"","eno":"","pphy":"GOPAL, MEENU ","ppno":8008056989,"pcpadd":"812 Amherst St,Ste 101","pcpcity":"Winchester  ","pcpstate":"VA","pcpzip":226013344,"pcpcounty":"","pcpid":"P9059167","pcpname":"VALLEY FAMILY PRACTICE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"224 SURREY CLUB LN","madd2":"","madd3":"","mcity":"STEPHENS CITY  ","mstate":"VA","mzip":"22655-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["N39.0","L20.89","L71.0","Z01.419","Z30.09","E55.9","Z23","N92.6","J02.9","Z00.00","Z30.41","Z63.4","F84.5","F90.9","F43.12","L20.9","J30.9","H91.13","H55.00","H52.4","K06.8","Z68.20","R05","F33.0","J01.90","Z03.818","N93.9","R31.9","N76.0","H90.3","R09.82","J31.0","R09.89","R05.9","R05.3","J30.1","J30.89","J30.81","J01.10","R05.1","J30.2","Z20.822"],"date":["2020-05-05","2020-11-19","2021-02-08","2020-12-10","2020-12-10","2021-02-08","2020-12-10","2021-01-06","2021-10-24","2021-01-06","2021-02-08","2021-02-08","2020-07-25","2020-07-25","2020-09-14","2021-10-28","2020-07-25","2020-07-25","2020-07-25","2020-07-25","2020-07-25","2020-07-25","2021-08-10","2021-04-14","2021-04-14","2021-04-15","2021-04-25","2021-04-22","2021-04-29","2021-08-10","2021-08-10","2021-10-28","2021-08-10","2021-10-24","2021-10-28","2021-11-17","2021-11-17","2021-11-17","2021-10-24","2021-10-24","2021-10-24","2021-10-24"],"priorHcc":["","","","","","","","","","","","","","","",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":[["","24591502","DUPIXENT","INJ 300\/2ML","","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","","Select","Select",""],["","65862019405","FLUOXETINE","CAP 40MG","","Select","Select",""],["","10702001150","HYDROXYZ HCL","TAB 25MG","","Select","Select",""],["","93742698","MONTELUKAST","TAB 10MG","","Select","Select",""],["","49884051101","MINOCYCLINE","TAB 50MG","","Select","Select",""],["","69238153106","LARISSIA","TAB ","","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","24591502","DUPIXENT ","INJ 300\/2ML","4","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","180","Select","Select",""],["","65862019405","FLUOXETINE ","CAP 40MG","90","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","49884051101","MINOCYCLINE ","50MG","60","Select","Select",""],["","69238153106","LARISSIA ","","84","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","10702001150","HYDROXYZ","25MG","180","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":""}]}]}