{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATRENIA D HATCHETT","gend":1,"add":"376 SHERANDO CT","city":"TIMBERVILLE ","state":"VA","zip":"22853-9998","dob":"1970-02-01","age":"","mstatus":"","insh":11013627,"cliId":"8VN2X74FR11","pno":5408786537,"cno":5402822952,"email":"","ename":"","eno":"","pphy":"ASISTORES, JASON LEO.G  ","ppno":5404773185,"pcpadd":"120 Medical Dr","pcpcity":"Mount Jackson  ","pcpstate":"VA","pcpzip":228429417,"pcpcounty":"","pcpid":"P9059035","pcpname":"RMH TIMBERVILLE HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"376 SHERANDO CT","madd2":"","madd3":"","mcity":"TIMBERVILLE ","mstate":"VA","mzip":"22853-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["B20","B18.2","M54.6","R10.9","R30.0","N10","N12","N28.89","R10.32","E83.42","R21","Z72.0","N30.00","F41.9","F17.210","B96.20","Z79.899","Z79.2","Z87.412","Z87.410","Z88.8","Z88.1","Z88.0","Z83.49","J06.9","R05","M54.9","Z23","M51.17","M51.37","M54.5","M54.16","M51.36","J45.20"],"date":["2021-07-29","2021-07-29","2020-08-06","2020-08-07","2020-08-06","2020-08-06","2020-08-10","2020-08-06","2020-08-06","2020-08-10","2020-08-10","2020-08-10","2020-08-10","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2020-08-20","2020-08-20","2020-09-17","2020-09-17","2020-10-02","2020-10-02","2020-10-02","2020-10-02","2020-10-02","2021-11-18"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","69097081312","GABAPENTIN","CAP 100MG","","Select","Select",""],["","59676057530","PREZCOBIX","TAB 800-150","","Select","Select",""],["","49702022813","TIVICAY","TAB 50MG","","Select","Select",""],["","52817032010","BACLOFEN","TAB 10MG","","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","17478071110","LIDOCAINE","GEL 2% JELLY","","Select","Select",""],["","65862041901","SMZ-TMP","TAB 400-80MG","","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","","Select","Select",""],["","57237005920","CEFUROXIME","TAB 500MG","","Select","Select",""],["","51672529404","MALATHION","LOT 0.005","","Select","Select",""],["","0","NYSTATIN","SUS 100000","","Select","Select",""],["","52817032010","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","69097081312","GABAPENTIN ","CAP 100MG","270","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","59676057530","PREZCOBIX ","TAB 800-150","30","Select","Select",""],["","49702022813","TIVICAY ","TAB 50MG","30","Select","Select",""],["","57237005920","CEFUROXIME ","TAB 500MG","20","Select","Select",""],["","378699252","ALBUTEROL ","NEB 1.25MG\/3","375","Select","Select",""],["","65862041901","SMZ-TMP ","TAB 400-80MG","30","Select","Select",""],["","17478071110","LIDOCAINE ","GEL 2% JELLY","240","Select","Select",""],["","51672529404","MALATHION ","LOT 0.005","59","Select","Select",""],["","0","NYSTATIN ","SUS 100000","360","Select","Select",""],["","00378699252","ALBUTEROL","1.25MG\/3","375","Select","Select",""],["","00173086910","ANORO","62.5-25","60","Select","Select",""],["","00310461612","BREZTRI","SPHERE","10.7","Select","Select",""],["","00310461612","BREZTRI ","AER SPHERE","10.7","Select","Select",""],["","00173086910","ANORO ","AER 62.5-25","60","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":""}]}]}