{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHELLEY WAGNER","gend":1,"add":"10511 WEST PROVIDENCE RD","city":"NORTH CHESTERFIELD","state":"VA","zip":232369999,"dob":"1960-03-20","age":"","mstatus":"","insh":11013438,"cliId":"7WM7KX0NC39","pno":8049674100,"cno":8046745780,"email":"","ename":"","eno":"","pphy":"FELTY, DANNY W","ppno":7575362246,"pcpadd":"500 Hioaks Rd Ste B","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232254061,"pcpcounty":"","pcpid":"P0124194","pcpname":"THE LAURELS OF BON AIR LLC","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R87.612","S46.812A","Z12.31","R60.0","I10","R53.83","R53.81","R63.5","R87.619","Z12.4","Z20.828","Z71.89","R73.9","R73.03","Z79.899"],"date":["2020-06-24","2020-07-06","2020-10-20","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-27","2020-11-18","2020-11-18","2020-11-18","2021-02-10"],"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":[["","13668000705","ZOLPIDEM","TAB 5MG","","Select","Select",""],["","70710114003","FLUCONAZOLE","TAB 200MG","","Select","Select",""],["","781716783","ESTRADIOL","DIS 0.1MG","","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","6483703","PNEUMOVAX 23","INJ 25\/0.5","","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","","Select","Select",""],["","169413212","OZEMPIC","INJ 2\/1.5ML","","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","93101042","MUPIROCIN","OIN 0.02","","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","","Select","Select",""],["","70436005901","BUPROPION","TAB 150MG SR","","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","70461032003","FLUCLVX QUAD","INJ 2020-21","","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}