{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BLANCA MARTICORENA","gend":1,"add":"1007   HERITAGE PLACE","city":"FREDERICKSBURG","state":"VA","zip":224019999,"dob":"1955-05-05","age":"","mstatus":"","insh":11014130,"cliId":"6YC5CX3QF64","pno":5712174315,"cno":"","email":"","ename":"","eno":"","pphy":"JOSEPH, CHERIAN","ppno":5402424141,"pcpadd":"101 Hospital Center Blvd","pcpcity":"Stafford","pcpstate":"VA","pcpzip":225546200,"pcpcounty":"","pcpid":"P0124745","pcpname":"CENTRE POINT HEALTH SPECIALTIES","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M25.561","E78.2","F20.9","R10.11","R10.84","R16.0","K76.0","I95.1","R00.1","R55","K42.9","R10.9","R39.81","M81.0","S30.861A","W57.XXXA","J45.40","K21.9","R87.619","R39.9","M25.562","Z23","Z12.31","R26.81","R53.81","K62.5","K59.00","Z53.8","R06.02","J45.901","R07.81","R05","M25.511","N94.10","Z03.818","R43.0","R43.9","R53.83","M94.0","I10","E78.5","E78.00","M19.90","Z20.828","R07.89","R07.9","K29.50","K31.89"],"date":["2020-10-30","2021-04-21","2021-04-21","2020-06-02","2020-12-09","2020-06-22","2020-09-24","2020-06-23","2020-06-23","2020-10-30","2020-07-02","2020-12-23","2021-02-15","2021-02-15","2020-08-12","2020-08-12","2020-08-12","2020-12-09","2020-10-13","2020-10-13","2021-04-21","2020-10-30","2021-04-21","2020-10-30","2020-10-30","2020-12-09","2020-11-16","2020-12-09","2020-12-25","2020-12-25","2020-12-25","2020-12-25","2021-02-10","2021-02-10","2020-12-20","2020-12-20","2020-12-20","2020-12-20","2020-12-23","2021-04-21","2020-12-23","2020-12-23","2020-12-23","2020-12-23","2020-12-23","2020-12-24","2020-12-09","2020-12-09"],"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":[["","68382005105","MELOXICAM","TAB 15MG","","Select","Select",""],["","27241000106","RISPERIDONE","TAB 1MG","","Select","Select",""],["","68180044801","QUETIAPINE","TAB 200MG","","Select","Select",""],["","70954000530","OXYBUTYNIN","TAB 5MG","","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","50111043303","TRAZODONE","TAB 50MG","","Select","Select",""],["","115166202","PROPRANOLOL","TAB 80MG","","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","","Select","Select",""],["","50228011410","FLUOXETINE","CAP 20MG","","Select","Select",""],["","68645052354","SERTRALINE","TAB 100MG","","Select","Select",""],["","93057610","LOVASTATIN","TAB 20MG","","Select","Select",""],["","64380076621","PEG-3350","SOL ELECTROL","","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","","Select","Select",""],["","781261305","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","31722094101","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","45802093716","HYDROCORT","LOT 0.025","","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}