{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LYNDIA J YOUNG","gend":1,"add":"3304 Woodlawn St Apt B  ","city":"Hopewell ","state":"VA","zip":"23860-4736","dob":"1959-11-02","age":"","mstatus":"","insh":11014570,"cliId":"6C35ME8EU87","pno":8047218561,"cno":8047218561,"email":"","ename":"","eno":"","pphy":"GADANI, MANU R ","ppno":8044582006,"pcpadd":"5303 Plaza Dr,Ste 101","pcpcity":"Hopewell ","pcpstate":"VA","pcpzip":238607331,"pcpcounty":"HOPEWELL CITY","pcpid":"P0124416","pcpname":"HOPEWELL HEALTH CARE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1300 Peterson Mill Rd","madd2":"","madd3":"","mcity":"Hopewell ","mstate":"VA","mzip":"23860-6928","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","E78.5","F33.1","H25.13","H52.4","H52.223","Z68.36","M85.88","N39.46","Z23"],"date":["2021-06-08","2021-06-08","2021-06-08","2020-10-16","2020-10-16","2020-10-16","2021-06-08","2021-06-08","2021-06-08","2021-07-08"],"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":[["","69097081312","GABAPENTIN","CAP 100MG","","Select","Select",""],["","70377000812","ROSUVASTATIN","TAB 20MG","","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","31722053705","LEVETIRACETA","TAB 500MG","","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","","Select","Select",""],["","69097081312","GABAPENTIN ","CAP 100MG","60","Select","Select",""],["","70377000812","ROSUVASTATIN ","TAB 20MG","90","Select","Select",""],["","16571020106","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","31722053705","LEVETIRACETA ","TAB 500MG","60","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","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","",""],["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":""}]}]}