{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRYCE ASHTON","gend":0,"add":"11826 PAFT DR  ","city":"FREDERICKSBURG ","state":"VA","zip":"22407-9998","dob":"2000-04-12","age":"","mstatus":"","insh":11014165,"cliId":"8E57YC0MQ46","pno":5402873596,"cno":5402873596,"email":"","ename":"","eno":"","pphy":"GALDAMEZ, GLORIA E","ppno":5408345440,"pcpadd":"12101 Carol Ln","pcpcity":"Fredericksburg ","pcpstate":"VA","pcpzip":224076101,"pcpcounty":"","pcpid":"P0136985","pcpname":"PRATT MEDICAL CENTER LTD","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"11826 PAFT DR  ","madd2":"","madd3":"","mcity":"FREDERICKSBURG ","mstate":"VA","mzip":"22407-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["L03.317","L05.92","L05.91","Z11.59","G40.209","R51.9","Z79.899","Z20.822","L05.01","F84.0","G40.909","G43.909","K21.9","J45.20","M54.2","R29.2"],"date":["2021-01-05","2021-01-08","2021-05-18","2021-01-13","2021-01-15","2021-01-15","2021-01-15","2021-09-14","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-05-28","2021-05-28","2020-10-19","2020-10-19"],"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":[["","50474059440","KEPPRA","TAB 250MG","","Select","Select",""],["","54092017312","CARBATROL","CAP 300MG","","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","115169449","EPINEPHRINE","INJ 0.3MG","","Select","Select",""],["","50474059440","KEPPRA ","TAB 250MG","300","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","20","Select","Select",""],["","54092017312","CARBATROL ","CAP 300MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","115169449","EPINEPHRINE ","INJ 0.3MG","4","Select","Select",""],["","59310057922","PROAIR ","","17","Select","Select",""],["","31722057330","ESOMEPRA ","40MG DR","30","Select","Select",""],["","59310057922","PROAIR","","17","Select","Select",""],["","31722057330","ESOMEPRA","40MG DR","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","",""],["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":""}]}]}