{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOY L MARTIN","gend":1,"add":"319 KENTUCKY AVENUE SW  ","city":"NORTON","state":"VA","zip":"24273-9998","dob":"1971-08-29","age":"","mstatus":"","insh":11014663,"cliId":"8UW0JU9UU21","pno":2763456967,"cno":2766794027,"email":"","ename":"","eno":"","pphy":"KUMAR, VIJAY","ppno":2763250121,"pcpadd":"610 PARK AVE NW","pcpcity":"NORTON","pcpstate":"VA","pcpzip":242730000,"pcpcounty":"","pcpid":"P9443259","pcpname":"KUMAR QUALITY MEDICAL CARE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"319 KENTUCKY AVENUE SW  ","madd2":"","madd3":"","mcity":"NORTON","mstate":"VA","mzip":"24273-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R39.81","K74.60","K75.81","I85.00","D69.6","D69.9","H40.013","E11.3293","E11.65","I10","E78.2","K21.9","K74.69","F41.9","Z79.899","F17.200","Z12.31","N32.81","L30.4","Z79.4","F41.8","J44.9","M15.0","E11.40","J30.9","H35.9","Z00.00","Z13.31","E78.5","E03.9","E11.9","R79.89","R16.0","K74.5","R29.6","J01.90","K59.00","R09.89","I65.21","R42","K80.20","I65.23","G45.9"],"date":["2021-11-28","2021-10-12","2021-09-02","2021-09-02","2021-03-02","2020-09-08","2021-10-08","2021-04-09","2021-04-07","2021-11-10","2020-10-19","2021-07-15","2020-10-19","2021-10-12","2020-10-19","2020-10-19","2021-09-21","2020-10-19","2020-10-19","2020-10-19","2021-10-06","2021-02-10","2021-11-10","2021-11-10","2021-04-07","2021-04-09","2021-05-17","2021-05-17","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-08-11","2021-08-11","2021-08-16","2021-08-16","2021-09-02","2021-09-09","2021-09-16","2021-09-16","2021-08-11","2021-11-18","2021-11-18"],"priorHcc":[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":[["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","832046515","NYAMYC","POW 100000","","Select","Select",""],["","13668000810","ZOLPIDEM","TAB 10MG","","Select","Select",""],["","65862067899","ALPRAZOLAM","TAB 1MG","","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","65862047099","LOSARTAN\/HCT","TAB 100-25","","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","16571012706","TOLTERODINE","TAB 2MG","","Select","Select",""],["","27241015504","OXYBUTYNIN","TAB 5MG ER","","Select","Select",""],["","68382009401","CARVEDILOL","TAB 12.5MG","","Select","Select",""],["","64764024060","AMITIZA","CAP 24MCG","","Select","Select",""],["","69315031228","PROCTO-MED","CRE HC 2.5%","","Select","Select",""],["","45802005935","NYSTATIN","CRE 100000","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","86227010105","SURE COMFORT","MIS 29GX1\/2\"","","Select","Select",""],["","169633910","NOVOLOG","INJ FLEXPEN","","Select","Select",""],["","23155010410","METFORMIN","TAB 1000MG","","Select","Select",""],["","67877022305","GABAPENTIN","CAP 300MG","","Select","Select",""],["","60505014100","GLIPIZIDE","TAB 5MG","","Select","Select",""],["","69046956","CHANTIX","TAB 1MG","","Select","Select",""],["","8470353001","UNIFINE PNTP","MIS 31GX8MM","","Select","Select",""],["","832532411","POT CL MICRO","TAB 10MEQ ER","","Select","Select",""],["","69315011710","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","68382013814","TOPIRAMATE","TAB 25MG","","Select","Select",""],["","169643810","LEVEMIR","INJ FLEXTOUC","","Select","Select",""],["","8222095121","PEN NEEDLES","MIS 29GX1\/2\"","","Select","Select",""],["","31722055190","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","57237001930","DULOXETINE","CAP 60MG","","Select","Select",""],["","16729017301","AMITRIPTYLIN","TAB 50MG","","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","","Select","Select",""],["","99073070827","FREESTYLE","TES LITE","","Select","Select",""],["","53885044801","ONETOUCH","KIT ULTRA 2","","Select","Select",""],["","143211250","DOXYCYCL HYC","TAB 100MG","","Select","Select",""],["","13668008130","MONTELUKAST","TAB 10MG","","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","68382013814","TOPIRAMATE ","TAB 25MG","180","Select","Select",""],["","169643810","LEVEMIR ","INJ FLEXTOUC","45","Select","Select",""],["","27241015504","OXYBUTYNIN ","TAB 5MG ER","90","Select","Select",""],["","832046515","NYAMYC ","POW 100000","30","Select","Select",""],["","69315011710","FUROSEMIDE ","TAB 40MG","60","Select","Select",""],["","68462039710","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","65862067899","ALPRAZOLAM ","TAB 1MG","90","Select","Select",""],["","13668000810","ZOLPIDEM ","TAB 10MG","30","Select","Select",""],["","65862047099","LOSARTAN\/HCT ","TAB 100-25","90","Select","Select",""],["","57237001999","DULOXETINE ","CAP 60MG","90","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","23155010410","METFORMIN ","TAB 1000MG","180","Select","Select",""],["","67877022305","GABAPENTIN ","CAP 300MG","270","Select","Select",""],["","69315031228","PROCTO-MED ","CRE HC 2.5%","28","Select","Select",""],["","31722055190","LEVOCETIRIZI ","TAB 5MG","90","Select","Select",""],["","45802005935","NYSTATIN ","CRE 100000","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","16571012706","TOLTERODINE ","TAB 2MG","60","Select","Select",""],["","60505014100","GLIPIZIDE ","TAB 5MG","270","Select","Select",""],["","64764024060","AMITIZA ","CAP 24MCG","180","Select","Select",""],["","69046956","CHANTIX ","TAB 1MG","56","Select","Select",""],["","832532411","POT  CL MICRO","TAB 10MEQ ER","270","Select","Select",""],["","68382009401","CARVEDILOL ","TAB 12.5MG","30","Select","Select",""],["","86227010105","SURE ","MIS 29GX1\/2\"","200","Select","Select",""],["","169633910","NOVOLOG ","INJ FLEXPEN","60","Select","Select",""],["","8470353001","UNIFINE ","MIS 31GX8MM","200","Select","Select",""],["","13668008190","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","8222095121","PEN  NEEDLES  ","MIS 29GX1\/2\"","200","Select","Select",""],["","16729017301","AMITRIPTYLIN ","TAB 50MG","30","Select","Select",""],["","143211250","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","173068220","VENTOLIN ","","18","Select","Select",""],["","53885044801","ONETOUCH ","ULTRA 2","1","Select","Select",""],["","69097052444","DICLOFENAC ","0.01","100","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","08470353001","UNIFINE","31GX8MM","200","Select","Select",""],["","69097052444","DICLOFENAC","0.01","100","Select","Select",""],["","99073070827","FREESTYLE TES LITE","LITE","100","Select","Select",""],["","00143211250","DOXYCYCL","100MG","20","Select","Select",""],["","86227010105","SURE","29GX1\/2\"","200","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","20","Select","Select",""],["","00456120230","LINZESS","290MCG","90","Select","Select",""],["","08290328203","BD PEN NEEDL","29GX12.7","200","Select","Select",""],["","68462056417","MUPIROCIN ","CRE 0.02","45","Select","Select",""],["","00169406012","VICTOZA ","INJ 18MG\/3ML","3","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","20","Select","Select",""],["","08290328203","BD  PEN NEEDL","MIS 29GX12.7","200","Select","Select",""],["","00456120230","LINZESS ","CAP 290MCG","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}