{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTOPHER CRAWFORD","gend":0,"add":"9716 RIVER BREEZE LANE  ","city":"POUND ","state":"VA","zip":"24279-9998","dob":"2000-10-28","age":"","mstatus":"","insh":11015505,"cliId":"4TD2N15PT15","pno":2767967373,"cno":2767967373,"email":"","ename":"","eno":"","pphy":"WALID SAADO ","ppno":2769265511,"pcpadd":"5476 Dickenson Hwy","pcpcity":"Clintwood","pcpstate":"VA","pcpzip":242287182,"pcpcounty":"","pcpid":"P9058975","pcpname":"POUND COMPREHENSIVE CLINIC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"9716 RIVER BREEZE LANE  ","madd2":"","madd3":"","mcity":"POUND ","mstate":"VA","mzip":"24279-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R53.83","Z13.6","F32.1","F41.1","F84.0","R45.1","F51.01","Q87.40","F90.9","K21.9"],"date":["2021-11-10","2020-11-04","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-05-13","2021-11-10"],"priorHcc":[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":[["","60505082901","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","29300014005","DIVALPROEX","TAB 500MG DR","","Select","Select",""],["","64980043710","ATENOLOL","TAB 25MG","","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","","Select","Select",""],["","70756080751","LANSOPRAZOLE","CAP 30MG DR","","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","64980043710","ATENOLOL ","TAB 25MG","90","Select","Select",""],["","70756080751","LANSOPRAZOLE ","CAP 30MG DR","90","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","135","Select","Select",""],["","29300014005","DIVALPROEX ","TAB 500MG DR","180","Select","Select",""],["","49281042150","FLUZONE","2021-22","0.5","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0.5","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":""}]}]}