{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JONATHAN L LOONEY","gend":0,"add":"1124 LYNN CAMP BRANCH ROAD ","city":"GRUNDY","state":"VA","zip":"24614-9998","dob":"1971-08-25","age":"","mstatus":"","insh":11015637,"cliId":"3YX9VM7FX15","pno":2765318214,"cno":2765318214,"email":"","ename":"","eno":"","pphy":"PATEL, HARESH J","ppno":2769352148,"pcpadd":"1520 Slate Creek Rd Ste 102","pcpcity":"Grundy","pcpstate":"VA","pcpzip":246146975,"pcpcounty":"","pcpid":"P9059111","pcpname":"TRI STATE CLINIC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1124 LYNN CAMP BRANCH ROAD ","madd2":"","madd3":"","mcity":"GRUNDY","mstate":"VA","mzip":"24614-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","E03.9","M51.17","E78.2","F34.1","Z79.01","Z95.2","I35.0","M54.5","K30","E78.00","Q23.0","E78.5","Z95.4","F41.1"],"date":["2021-11-11","2021-11-11","2021-10-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-07-13","2021-03-03","2021-03-03","2021-03-03","2020-12-15","2021-07-13","2021-06-14","2021-08-31"],"priorHcc":[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":[["","71093011105","GABAPENTIN","TAB 600MG","","Select","Select",""],["","378180010","LEVOTHYROXIN","TAB 25MCG","","Select","Select",""],["","93719805","FLUOXETINE","CAP 40MG","","Select","Select",""],["","60505267109","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","57664047758","METOPROL TAR","TAB 50MG","","Select","Select",""],["","603389032","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","68180056701","TRANDOLAPRIL","TAB 2MG","","Select","Select",""],["","93171601","WARFARIN","TAB 4MG","","Select","Select",""],["","71093011105","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","60505267109","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","68180056701","TRANDOLAPRIL ","TAB 2MG","30","Select","Select",""],["","57664047758","METOPROL ","TAB 50MG","60","Select","Select",""],["","378180010","LEVOTHYROXIN ","TAB 25MCG","30","Select","Select",""],["","93171601","WARFARIN ","TAB 4MG","60","Select","Select",""],["","93719805","FLUOXETINE ","CAP 40MG","30","Select","Select",""],["","603389032","HYDROCO\/APAP ","TAB 5-325MG","30","Select","Select",""],["","57664047758","METOPROL","50MG","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","",""],["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":""}]}]}