{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROY HOPKINS","gend":0,"add":"8077 GOLD DALE ROAD  ","city":"LOCUST GROVE","state":"VA","zip":"22508-9998","dob":"1953-04-12","age":"","mstatus":"","insh":11013527,"cliId":"8N62W26TX02","pno":5408402469,"cno":5408402469,"email":"","ename":"","eno":"","pphy":"AMEEN, RICHARD J  ","ppno":5407869771,"pcpadd":"12006 Kilarney Dr","pcpcity":"Fredericksburg ","pcpstate":"VA","pcpzip":224077207,"pcpcounty":"","pcpid":"P9413480","pcpname":"CHANCELLOR INTERNAL MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"8077 GOLD DALE ROAD  ","madd2":"","madd3":"","mcity":"LOCUST GROVE","mstate":"VA","mzip":"22508-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["G47.33","R06.00","G89.29","J30.0","J30.1","Z20.828","G89.4","Z79.899","M79.7","I10","E78.2","E55.9","E53.8","M17.10","M17.12","R05","H91.93","J45.909","M25.569","M13.80","E78.5","Z68.30","D50.9","M25.551","M16.11","M62.838"],"date":["2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2020-11-30","2021-03-30","2021-03-30","2021-03-30","2021-11-17","2021-11-17","2021-02-24","2021-02-24","2021-03-30","2021-05-07","2021-09-14","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2021-11-17","2021-10-26","2021-10-26","2021-10-26"],"priorHcc":["","","","","","","","","",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":[["","16729018201","HYDROCHLOROT","TAB 12.5MG","","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","65862020390","LOSARTAN POT","TAB 100MG","","Select","Select",""],["","70377002711","ATORVASTATIN","TAB 10MG","","Select","Select",""],["","24208039830","IPRATROPIUM","SPR 0.0003","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","16571020106","DICLOFENAC ","TAB 75MG DR","180","Select","Select",""],["","70377002711","ATORVASTATIN ","TAB 10MG","90","Select","Select",""],["","65862020390","LOSARTAN ","TAB 100MG","90","Select","Select",""],["","16729018201","HYDROCHLOROT ","TAB 12.5MG","90","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","48","Select","Select",""],["","24208039830","IPRATROPIUM ","SPR 0.0003","90","Select","Select",""],["","93317431","ALBUTEROL ","E","8.5","Select","Select",""],["","65862020390","LOSARTAN","100MG","90","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","00093342210","CYCLOBENZAPR ","TAB 10MG","90","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":""}]}]}