{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANETTE PAULK","gend":1,"add":"143 MARYLAND AVE APT 1","city":"PORTSMOUTH                    ","state":"VA","zip":"23707-9998","dob":"1973-12-12","age":"","mstatus":"","insh":11015181,"cliId":"8U49DY5QT27","pno":7573004730,"cno":7576478447,"email":"","ename":"","eno":"","pphy":"SKINNER, ALISON C","ppno":7577381600,"pcpadd":"3253 Taylor Rd,Ste 200","pcpcity":"Chesapeake","pcpstate":"VA","pcpzip":233212452,"pcpcounty":"","pcpid":"P0060087","pcpname":"WESTERN BRANCH FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"APARTMENT 1","add3":"","madd1":"143 MARYLAND AVE APT 1","madd2":"APARTMENT 1","madd3":"","mcity":"PORTSMOUTH","mstate":"VA","mzip":"23707-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["K58.9","Z13.6","Z00.00","Z23","M46.1","F31.9","F11.20","F13.20","F41.9","F90.9","G89.4","M79.7","F43.21","E55.9","F17.200","N81.10","R31.9","N30.00","N31.9","Z12.11","Z12.31","Z87.891","G56.03"],"date":["2021-07-12","2021-01-26","2021-01-26","2021-10-11","2021-01-26","2021-07-12","2021-01-26","2021-01-26","2021-10-11","2021-10-11","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-01","2021-06-02","2021-06-02","2021-07-01","2021-10-11","2021-10-11","2021-10-11","2021-10-11"],"priorHcc":["","","",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":[["","172392660","DIAZEPAM","TAB 5MG","","Select","Select",""],["","63304082805","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","31722082930","ARIPIPRAZOLE","TAB 20MG","","Select","Select",""],["","527150637","AMPHET\/DEXTR","TAB 30MG","","Select","Select",""],["","93738201","VENLAFAXINE","TAB 75MG","","Select","Select",""],["","172392680","DIAZEPAM ","TAB 5MG","90","Select","Select",""],["","63304082805","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","527150637","AMPHET\/DEXTR ","TAB 30MG","60","Select","Select",""],["","62332001131","VENLAFAXINE ","TAB 75MG","90","Select","Select",""],["","31722082930","ARIPIPRAZOLE ","TAB 20MG","30","Select","Select",""],["","16729020301","BUSPIRONE","15MG","60","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":""}]}]}