{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RENEE STANLEY","gend":1,"add":"2302 ROCKLEDGE ROAD  ","city":"BIG STONE GAP  ","state":"VA","zip":"24219-4034","dob":"1968-06-01","age":"","mstatus":"","insh":11015519,"cliId":"5YX8AP5UN37","pno":2762073810,"cno":2762072161,"email":"","ename":"","eno":"","pphy":"BASHAM, CHRISTOPHER M","ppno":2766790321,"pcpadd":"295 Wharton Ln NE","pcpcity":"Norton","pcpstate":"VA","pcpzip":242731541,"pcpcounty":"","pcpid":"P9059237","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2302 ROCKLEDGE ROAD  ","madd2":"","madd3":"","mcity":"BIG STONE GAP  ","mstate":"VA","mzip":"24219-4034","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E03.9","L93.0","M54.9","M25.561","F41.9","I10","R10.2","M53.3","M47.817","M25.50","M25.552","M54.2","M70.62","M24.859","M24.159","Z01.818","M16.12","Z01.810","K21.9","F32.9","M54.5","M24.152","M13.811","M67.823","E78.5","E66.9","Z00.00","E55.9","R25.2","Z79.899","M62.838","M51.36","M48.061","R30.0"],"date":["2021-10-14","2021-10-14","2021-10-14","2020-10-02","2021-10-14","2021-10-14","2020-12-31","2021-10-13","2021-09-15","2020-12-03","2020-12-03","2021-01-15","2021-01-15","2021-01-15","2021-01-28","2021-02-15","2021-02-19","2021-02-15","2021-02-19","2021-02-19","2020-12-31","2021-01-28","2021-03-23","2021-03-23","2021-07-14","2021-04-22","2021-08-04","2021-04-22","2021-07-14","2021-07-14","2021-07-14","2021-09-08","2021-09-08","2021-09-22"],"priorHcc":[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":[["","65162062711","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","378180310","LEVOTHYROXIN","TAB 50MCG","","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","54011825","ROPINIROLE","TAB 1MG","","Select","Select",""],["","68180047903","SIMVASTATIN","TAB 20MG","","Select","Select",""],["","53746046605","IBUPROFEN","TAB 800MG","","Select","Select",""],["","50111064844","FLUOXETINE","CAP 20MG","","Select","Select",""],["","172572880","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","53746046605","IBUPROFEN ","TAB 800MG","90","Select","Select",""],["","68462039710","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","50111064844","FLUOXETINE ","CAP 20MG","60","Select","Select",""],["","68180047903","SIMVASTATIN ","TAB 20MG","30","Select","Select",""],["","172572880","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","378180310","LEVOTHYROXIN ","TAB 50MCG","30","Select","Select",""],["","54011825","ROPINIROLE ","TAB 1MG","30","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","240","Select","Select",""],["","65162062711","TRAMADOL","50MG","240","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","",""],["Yes","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":""}]}]}