{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICARDA PEREZ-NAVEDO","gend":1,"add":"145 ECHO VALLEY CIRCLE  ","city":"WYTHEVILLE  ","state":"VA","zip":"24382-9998","dob":"1963-08-05","age":"","mstatus":"","insh":11014181,"cliId":"1Y39KY6JK49","pno":2766982105,"cno":2766982105,"email":"","ename":"","eno":"","pphy":"MCCONNELL, JAMES J","ppno":2762288951,"pcpadd":"365 W Ridge Rd","pcpcity":"Wytheville  ","pcpstate":"VA","pcpzip":243821008,"pcpcounty":"","pcpid":"P0124187","pcpname":"JAMES J MCCONNELL MD PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"145 ECHO VALLEY CIRCLE  ","madd2":"","madd3":"","mcity":"WYTHEVILLE  ","mstate":"VA","mzip":"24382-9998","pcpfaxno":"                    ","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["K22.2","R13.10","C15.5","Z08","Z85.01","Z92.21","Z92.3","K80.20","K22.8","Z93.1","B20","D72.829","E86.0","G89.3","I10","C15.9","H04.301","H04.551","Z20.828","Z01.812","Z01.818","H04.511","H04.201","K21.9","Z21","I12.9","N18.4","Z85.6","H91.90","J45.909","M19.90","K75.89","Z79.899","H04.219","H04.411","Z01.810","R93.3","R19.5","I70.90","H25.13","J45.21","Q39.1","K44.9"],"date":["2021-11-05","2021-11-06","2021-11-06","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-06","2020-11-07","2021-05-04","2021-03-13","2020-11-16","2020-11-16","2020-11-16","2020-11-16","2021-11-06","2021-03-18","2021-03-18","2021-02-16","2021-03-13","2021-03-13","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-05-04","2021-05-04","2021-05-04","2021-07-27","2021-10-12","2021-11-06","2021-11-06"],"priorHcc":[null,null,null,null,null,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":[["","31722057330","ESOMEPRA MAG","CAP 40MG DR","","Select","Select",""],["","49702022813","TIVICAY","TAB 50MG","","Select","Select",""],["","61958200201","DESCOVY","TAB 200\/25","","Select","Select",""],["","23916360","RESTASIS","EMU 0.0005","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","49702022418","SELZENTRY","TAB 300MG","","Select","Select",""],["","93221001","SUCRALFATE","TAB 1GM","","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","","Select","Select",""],["","23155022701","ACYCLOVIR","TAB 400MG","","Select","Select",""],["","24208055555","BACIT\/POLYMY","OIN OP","","Select","Select",""],["","472016630","NYSTATIN","OIN 100000","","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","","Select","Select",""],["","24208029505","TOBRA\/DEXAME","SUS 0.3-0.1%","","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","10","Select","Select",""],["","24208029505","TOBRA\/DEXAME ","SUS 0.3-0.1%","5","Select","Select",""],["","49702022418","SELZENTRY ","TAB 300MG","60","Select","Select",""],["","31722057330","ESOMEPRA ","CAP 40MG DR","60","Select","Select",""],["","61958200201","DESCOVY ","TAB 200\/25","30","Select","Select",""],["","49702022813","TIVICAY ","TAB 50MG","30","Select","Select",""],["","23916360","RESTASIS ","EMU 0.0005","60","Select","Select",""],["","472016615","NYSTATIN ","OIN 100000","15","Select","Select",""],["","93221001","SUCRALFATE ","TAB 1GM","360","Select","Select",""],["","65162052110","PROMETHAZINE ","TAB 25MG","60","Select","Select",""],["","65862039110","ONDANSETRON ","TAB 8MG ODT","30","Select","Select",""],["","23155022701","ACYCLOVIR ","TAB 400MG","90","Select","Select",""],["","24208055555","BACIT\/POLYMY ","OIN OP","3.5","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","15","Select","Select",""],["","31722057330","ESOMEPRA","40MG DR","60","Select","Select",""],["","42571013725","KETOROLAC","0.50%","5","Select","Select",""],["","69315030805","CIPROFLOXACN","0.3% OP","5","Select","Select",""],["","60758011905","PREDNISOLONE","1% OP","5","Select","Select",""],["","00378827052","ALBUTEROL","0.08%","75","Select","Select",""],["","00527518070","SMZ-TMP","200-40\/5","600","Select","Select",""],["","59310057922","PROAIR","","17","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","17","Select","Select",""],["","65862041901","SMZ-TMP ","TAB 400-80MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","17","Select","Select",""],["","60758011905","PREDNISOLONE ","SUS 1% OP","5","Select","Select",""],["","42571013725","KETOROLAC ","SOL 0.005","5","Select","Select",""],["","69315030805","CIPROFLOXACN ","SOL 0.3% OP","5","Select","Select",""],["","00121090204","PRED ","SOL 5MG\/5ML","150","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","",""],["Yes","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":""}]}]}