{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JASMINE BRAGG","gend":1,"add":"405 CHURCH STREET ","city":"KENBRIDGE","state":"VA","zip":"23944-2049","dob":"1997-05-21","age":"","mstatus":"","insh":11013339,"cliId":"7T83N20YW83","pno":4342621089,"cno":8044189114,"email":"","ename":"","eno":"","pphy":"POWERS, DAVID C","ppno":4346768021,"pcpadd":"200 E 5th St","pcpcity":"Chase City  ","pcpstate":"VA","pcpzip":239241456,"pcpcounty":"Mecklenburg","pcpid":"P0060193","pcpname":"KENBRIDGE FAMILY MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"405 CHURCH STREET ","madd2":"","madd3":"","mcity":"KENBRIDGE","mstate":"VA","mzip":"23944-2049","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z86.19","Z68.43","M67.441","E66.01","M85.9","Z11.8","Z00.01","Z12.31","Z72.89","Z00.00","Z12.11","K02.9","Z11.59","I10","R03.0","Z23","L21.9","L81.4","N60.12","N64.89","N91.2","R55","R42","L81.0","R23.2","I45.81","E66.9","Z68.34","H92.02","N39.0","Z11.3","Z72.51","L81.9","R51.9","R11.0","Z76.89"],"date":["2020-06-11","2021-07-22","2020-06-11","2021-07-15","2020-07-10","2020-07-10","2020-07-10","2020-12-11","2021-07-15","2021-07-15","2021-07-15","2020-07-28","2020-07-28","2021-07-15","2020-08-27","2021-07-15","2021-07-15","2020-12-10","2020-12-22","2020-12-22","2021-02-16","2021-03-16","2021-07-22","2021-04-12","2021-02-16","2021-02-16","2020-10-03","2020-10-03","2021-06-14","2021-07-15","2021-07-15","2021-07-01","2021-07-15","2021-07-22","2021-07-20","2021-07-22"],"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":[["","45802004064","SELENIUM SUL","LOT 0.025","","Select","Select",""],["","45802005505","TRIAMCINOLON","OIN 0.001","","Select","Select",""],["","168014630","HYDROCORT","OIN 0.025","","Select","Select",""],["","68001025320","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","45802048526","FLUOCIN ACET","OIL 0.01% SC","","Select","Select",""],["","168009960","KETOCONAZOLE","CRE 0.02","","Select","Select",""],["","116200116","CHLORHEX GLU","SOL 0.0012","","Select","Select",""],["","591034705","HYDROCHLOROT","CAP 12.5MG","","Select","Select",""],["","781261305","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","45802004064","SELENIUM ","LOT 0.025","120","Select","Select",""],["","45802005505","TRIAMCINOLON ","OIN 0.001","30","Select","Select",""],["","168009960","KETOCONAZOLE ","CRE 0.02","60","Select","Select",""],["","591034705","HYDROCHLOROT ","CAP 12.5MG","90","Select","Select",""],["","68001025320","FLUCONAZOLE ","TAB 150MG","8","Select","Select",""],["","51672135708","FLUOCIN ","OIL 0.01% SC","118.28","Select","Select",""],["","168014630","HYDROCORT ","OIN 0.025","28.35","Select","Select",""],["","17478071310","OFLOXACIN ","0.3% OP","10","Select","Select",""],["","42571016142","AMOX\/K ","500-125","14","Select","Select",""],["","116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","781261305","AMOXICILLIN ","500MG","21","Select","Select",""],["","68001042300","NITROFURANTN ","100MG","10","Select","Select",""],["","70010049105","METFORMIN ","ORAL TAB","90","Select","Select",""],["","68001042300","NITROFURANTN","100MG","10","Select","Select",""],["","45802004064","SELENIUM","0.025","120","Select","Select",""],["","42571016142","AMOX\/K","500-125","14","Select","Select",""],["","70010049105","METFORMIN","ORAL TAB","90","Select","Select",""],["","17478071310","OFLOXACIN","0.3% OP","10","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","","30","Select","Select",""],["","00116200116","CHLORHEX","0.0012","473","Select","Select",""],["","59746017506","PREDNISONE","20MG","5","Select","Select",""],["","68001016200","PROMETHAZINE","25MG","12","Select","Select",""],["","51672135708","FLUOCIN","0.01% SC","118.28","Select","Select",""],["","59746017506","PREDNISONE ","TAB 20MG","5","Select","Select",""],["","10702025350","BUT\/APAP\/CAF ","TAB ","30","Select","Select",""],["","68001016200","PROMETHAZINE ","TAB 25MG","12","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":""}]}]}