{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ESTELLE ROSE","gend":1,"add":"5468 TRENTS MILL ROAD","city":"DILLWYN  ","state":"VA","zip":"23936-2772","dob":"1942-02-04","age":"","mstatus":"","insh":11013924,"cliId":"3JP4FQ7PU85","pno":8049831540,"cno":4349831540,"email":"","ename":"","eno":"","pphy":"MULLER, RICHARD A ","ppno":4346548900,"pcpadd":"65 Brickyard Dr","pcpcity":"Dillwyn  ","pcpstate":"VA","pcpzip":239363361,"pcpcounty":"","pcpid":"P9307279","pcpname":"BUCKINGHAM FAMILY MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"5468 TRENTS MILL ROAD","madd2":"","madd3":"","mcity":"DILLWYN  ","mstate":"VA","mzip":"23936-2772","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E11.65","I10","E78.2","J30.9","M12.9"],"date":["2021-06-03","2021-06-03","2021-06-03","2020-07-17","2021-06-03"],"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":[["","16571020150","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","781286810","OMEPRAZOLE","CAP 20MG DR","","Select","Select",""],["","55111032205","GLIMEPIRIDE","TAB 4MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","62175089143","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","68180051703","LISINOPRIL","TAB 40MG","","Select","Select",""],["","67877019905","AMLODIPINE","TAB 10MG","","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","","Select","Select",""],["","6027754","JANUVIA","TAB 100MG","","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","90","Select","Select",""],["","16729000301","GLIMEPIRIDE ","TAB 4MG","19","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","781286810","OMEPRAZOLE ","CAP 20MG DR","30","Select","Select",""],["","68180051703","LISINOPRIL ","TAB 40MG","90","Select","Select",""],["","62175089143","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","67877019905","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","6027754","JANUVIA ","TAB 100MG","90","Select","Select",""],["","173068220","VENTOLIN ","AER ","18","Select","Select",""],["","378003210","METOPROL ","50MG","180","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","00378003210","METOPROL","50MG","180","Select","Select",""],["","00173068220","VENTOLIN","","18","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}