{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NICOLE MCMULLEN","gend":1,"add":"7204 TWIN CEDARS DR  ","city":"WOODFORD ","state":"VA","zip":"22580-9998","dob":"1973-01-21","age":"","mstatus":"","insh":11014933,"cliId":"6E42NK3KQ05","pno":5403720190,"cno":5403720190,"email":"","ename":"","eno":"","pphy":"MANDELL, STEPHEN  ","ppno":8046335840,"pcpadd":"121 Courthouse Ln","pcpcity":"Bowling Green  ","pcpstate":"VA","pcpzip":224279336,"pcpcounty":"","pcpid":"P0124062","pcpname":"VIRGINIA PRIMARY CARE ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"7204 TWIN CEDARS DR  ","madd2":"","madd3":"","mcity":"WOODFORD ","mstate":"VA","mzip":"22580-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["K21.0","R07.89","R11.2","R07.9","I49.5","G24.9","Z99.3","Z86.718","Z87.442","H91.90","Z95.0","Z82.49","F33.3","Z76.0","Z45.018","I47.2","R56.9","F17.200","Z90.721","Z83.3","F25.0","M25.561","Z87.81","Z87.828","Z79.899"],"date":["2020-08-17","2020-08-17","2020-08-17","2020-08-17","2021-01-10","2020-08-17","2021-08-15","2021-08-15","2021-02-25","2020-08-17","2021-08-15","2020-08-17","2021-03-29","2021-01-10","2020-11-09","2020-11-09","2021-02-25","2021-08-15","2021-02-25","2021-02-25","2021-10-14","2021-08-15","2021-08-15","2021-08-15","2021-10-14"],"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":[["","57237004705","DIVALPROEX","TAB 250MG DR","","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","","Select","Select",""],["","832154011","HALOPERIDOL","TAB 5MG","","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","57237004705","DIVALPROEX ","TAB 250MG DR","90","Select","Select",""],["","50111056001","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","69097083512","SERTRALINE ","TAB 100MG","45","Select","Select",""],["","65862052305","GABAPENTIN ","TAB 600MG","30","Select","Select",""],["","832154011","HALOPERIDOL ","TAB 5MG","60","Select","Select",""],["","65162052110","PROMETHAZINE ","TAB 25MG","20","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","49483060350","IBUPROFEN","600MG","20","Select","Select",""],["","49483060350","IBUPROFEN ","TAB 600MG","20","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":""}]}]}