{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICKY L PERDUE JR","gend":0,"add":"1151 DAWN PLACE","city":"GOODVIEW ","state":"VA","zip":"24095-9998","dob":"1993-07-23","age":"","mstatus":"","insh":11015307,"cliId":"8DX2KM9WH13","pno":5403147548,"cno":5403147548,"email":"","ename":"","eno":"","pphy":"ANDREWS, CLARKE B ","ppno":5409925994,"pcpadd":"1935 WEST MAIN STREET","pcpcity":"SALEM ","pcpstate":"VA","pcpzip":241533109,"pcpcounty":"","pcpid":"P0125174","pcpname":"CARILION FAMILY MEDICINE PARKWAY PHYSICIANS VINT","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1151 DAWN PLACE","madd2":"","madd3":"","mcity":"GOODVIEW ","mstate":"VA","mzip":"24095-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F31.0","S06.0X1A","S09.90XA","W20.8XXA","M54.6","F41.1","F17.210","Z79.51","S19.9XXA","A05.9","R11.2","R10.13","J45.20","M79.601","I82.621","I82.601","M25.571","S93.401A","J30.9","X50.0XXA","S99.911A","R52","R10.84","R11.0","R11.11"],"date":["2021-11-17","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2021-02-03","2020-10-07","2020-10-07","2020-11-04","2020-11-04","2020-11-04","2021-02-03","2021-01-22","2021-02-03","2021-01-29","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2020-11-04","2020-11-04","2020-11-04","2020-11-04"],"priorHcc":[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":[["","3376474","ELIQUIS ST P","TAB 5MG","","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","185067401","HYDROXYZ PAM","CAP 25MG","","Select","Select",""],["","65862022701","LAMOTRIGINE","TAB 25MG","","Select","Select",""],["","65862022701","LAMOTRIGINE ","TAB 25MG","106","Select","Select",""],["","185067401","HYDROXYZ ","CAP 25MG","90","Select","Select",""],["","3376474","ELIQUIS ","TAB 5MG","74","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","7","Select","Select",""],["","00185067401","HYDROXYZ","25MG","90","Select","Select",""],["","00003376474","ELIQUIS","5MG","74","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":""}]}]}