{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VICKIE S BREEDEN","gend":1,"add":"422 Comertown Rd  ","city":"Shenandoah  ","state":"VA","zip":"22849-4010","dob":"1952-11-30","age":"","mstatus":"","insh":11013442,"cliId":"7KF5YV1JU80","pno":5407422647,"cno":5407422647,"email":"","ename":"","eno":"","pphy":"WILLIAMS, MEGAN A.","ppno":5404334913,"pcpadd":"1380 Little Sorrell Dr Ste 100","pcpcity":"Harrisonburg","pcpstate":"VA","pcpzip":228017372,"pcpcounty":"","pcpid":"P9058691","pcpname":"HARRISONBURG COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"422 COMERTOWN RD  ","madd2":"","madd3":"","mcity":"SHENANDOAH  ","mstate":"VA","mzip":"22849-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R26.89","Z96.651","M17.12","M25.561","I10"],"date":["2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-07-13"],"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":[]},{"a":[]}]},{"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":[["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","68001040100","FLUOXETINE","40MG","30","Select","Select",""],["","16729020001","BUSPIRONE","5MG","60","Select","Select",""],["","60505257908","ATORVASTATIN","20MG","30","Select","Select",""],["","68180021509","LOSARTAN\/HCT","50-12.5","30","Select","Select",""],["","68001028103","DICLOFENAC","75MG DR","60","Select","Select",""],["","67877019805","AMLODIPINE","5MG","30","Select","Select",""],["","00378023110","ATENOLOL","50MG","30","Select","Select",""],["","33332042010","AFLURIA","2020-21","0.5","Select","Select",""],["","70461042010","FLUCLVX","2020-21","0.5","Select","Select",""],["","60505257908","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","68001040100","FLUOXETINE ","CAP 40MG","30","Select","Select",""],["","67877019805","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","00378023110","ATENOLOL ","TAB 50MG","30","Select","Select",""],["","16729020001","BUSPIRONE ","TAB 5MG","60","Select","Select",""],["","68180021509","LOSARTAN\/HCT ","TAB 50-12.5","30","Select","Select",""],["","68001028103","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","33332032101","AFLURIA ","INJ 2021-22","0.5","Select","Select",""],["","70461042010","FLUCLVX ","INJ 2020-21","0.5","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","",""],["Yes","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":""}]}]}