{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAY L WADDELL","gend":1,"add":"P.O. BOX 48","city":"WHITE POST                    ","state":"VA","zip":"22663-0048","dob":"1928-03-01","age":"","mstatus":"","insh":11013443,"cliId":"7PW9EG0HN46","pno":5403036718,"cno":5403036718,"email":"","ename":"","eno":"","pphy":"MIDDELHOF, CHARLES A                                        ","ppno":5408682511,"pcpadd":"640 Warrior Dr Ste 109,","pcpcity":"Stephens City                 ","pcpstate":"VA","pcpzip":226554076,"pcpcounty":"","pcpid":"P9059168","pcpname":"VALLEY FAMILY AND PROCEDURAL MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"P.O. BOX 48","madd2":"","madd3":"","mcity":"WHITE POST                    ","mstate":"VA","mzip":"22663-0048","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["L22","R39.81","N39.41","C71.9","K44.9","N17.9","N39.0","G93.41","I13.0","E87.2","N18.3","L89.159","I48.91","G20","F02.80","Z66","E87.8","R33.9","G89.4","H26.9","M19.90","B96.89","R53.1","R52","K92.0","R06.02","J90","J98.11","R10.9","T83.511A","B96.20","K92.2","R10.11","Y84.6","F32.9","I50.9","N18.30","M81.8","E66.9","E87.6","R11.2","F03.90","Z46.82","R91.8","K31.89","K40.90","K52.9","I48.20","I10","Z20.822","K56.41","R31.9","R07.9","R10.84","R78.81","Z91.81","Z74.01","I50.32","B96.5","N18.31","L89.152","M81.0","G89.29","F02.81","K57.30","K59.03","T40.2X5A","D50.9","M47.9","N31.9","Z87.440","E86.0","Z79.891","Z16.23","K80.50","Z53.20","N28.89","Z96.0","R54","K80.67","Z46.6","R41.82","R50.9","N18.4","I50.30","K21.9","Z51.5","I48.0","N18.9","F39","K59.00","R14.0","T83.511D","Z71.89","L89.322","M15.9","R93.3","I12.9"],"date":["2021-06-04","2021-06-04","2021-06-04","2021-08-02","2021-03-31","2020-09-11","2021-05-10","2020-08-07","2021-05-05","2020-08-10","2020-09-11","2020-08-07","2021-05-09","2021-04-06","2021-04-02","2021-03-31","2020-08-10","2020-08-07","2020-08-07","2020-08-07","2021-05-05","2020-08-07","2021-03-30","2021-02-25","2021-03-25","2020-12-06","2021-02-20","2021-03-08","2021-04-05","2021-05-05","2021-04-02","2020-12-08","2020-12-08","2021-05-05","2021-03-11","2021-03-31","2020-12-14","2021-05-05","2020-12-06","2020-12-06","2021-05-07","2021-03-25","2020-12-07","2020-12-07","2020-12-09","2021-02-20","2021-02-21","2021-04-15","2021-05-05","2021-05-05","2021-02-20","2021-02-20","2021-02-22","2021-03-08","2021-02-24","2020-12-11","2021-03-25","2021-02-20","2021-05-05","2021-03-11","2021-04-15","2021-02-20","2021-05-05","2021-02-25","2021-05-07","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-05-05","2021-03-11","2021-03-08","2021-04-06","2021-03-31","2021-04-06","2021-03-31","2021-03-31","2021-03-31","2021-05-10","2021-04-01","2021-04-28","2021-05-05","2021-05-05","2021-05-09","2021-05-05","2021-05-05","2021-05-10","2021-05-05","2021-05-05","2021-05-05","2021-05-09","2021-05-07","2021-05-10","2021-05-10","2020-09-11","2021-02-11","2021-04-02","2020-12-14"],"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":[["","406012305","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","43547035211","LISINOPRIL","TAB 5MG","","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","185012201","NITROFURANTN","CAP 100MG","","Select","Select",""],["","65862041901","SMZ-TMP","TAB 400-80MG","","Select","Select",""],["","65862009620","CEFPODOXIME","TAB 200MG","","Select","Select",""],["","65862007601","CIPROFLOXACN","TAB 250MG","","Select","Select",""],["","57237000430","FLUCONAZOLE","TAB 100MG","","Select","Select",""],["","67877024201","QUETIAPINE","TAB 25MG","","Select","Select",""],["","406905076","FENTANYL","DIS 50MCG\/HR","","Select","Select",""],["","45963070911","METOPROL SUC","TAB 25MG ER","","Select","Select",""],["","378623101","CITALOPRAM","TAB 10MG","","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","","Select","Select",""],["","93314705","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","574200815","NYSTOP","POW 100000","","Select","Select",""],["","406012305","HYDROCO\/APAP ","TAB 5-325MG","30","Select","Select",""],["","65862007601","CIPROFLOXACN ","TAB 250MG","14","Select","Select",""],["","185012201","NITROFURANTN ","CAP 100MG","20","Select","Select",""],["","43547035211","LISINOPRIL ","TAB 5MG","90","Select","Select",""],["","67877024201","QUETIAPINE ","TAB 25MG","45","Select","Select",""],["","62175011843","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","67877021560","CEFUROXIME ","TAB 250MG","14","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","30","Select","Select",""],["","406905076","FENTANYL ","DIS 50MCG\/HR","10","Select","Select",""],["","65862041901","SMZ-TMP ","TAB 400-80MG","14","Select","Select",""],["","65862009620","CEFPODOXIME ","TAB 200MG","14","Select","Select",""],["","45963070911","METOPROL ","TAB 25MG ER","8","Select","Select",""],["","378623101","CITALOPRAM ","TAB 10MG","90","Select","Select",""],["","57237000430","FLUCONAZOLE ","TAB 100MG","7","Select","Select",""],["","93314705","CEPHALEXIN ","CAP 500MG","10","Select","Select",""],["","574200815","NYSTOP ","POW 100000","15","Select","Select",""],["","45963070911","METOPROL","25MG ER","8","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","",""],["Yes","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":""}]}]}