{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AUDREY T JACKSON BOWLER","gend":1,"add":"6428 Macedonia Rd","city":"Woodford                      ","state":"VA","zip":"22580-3310","dob":"1950-01-02","age":"","mstatus":"","insh":11015790,"cliId":"9AV0K82RD37","pno":5402422276,"cno":5402422276,"email":"","ename":"","eno":"","pphy":"GUIRGUIS, EKRAM G","ppno":5407365043,"pcpadd":"4370 Starkey Rd,Ste 4A","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240180603,"pcpcounty":"","pcpid":"P9058813","pcpname":"MARY WASHINGTON HEALTHCARE PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"N","ano":"","add2":"","add3":"","madd1":"6428 Macedonia Rd","madd2":"","madd3":"","mcity":"Woodford","mstate":"VA","mzip":"22580-3310","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["H25.813","H35.033","I10","E78.00","H04.123","H52.11","H52.02","H52.4","H52.221","L08.9","M79.641","R21","E78.5","J44.9","F17.210","F41.1","R10.2","R53.1","E03.9","R42","E55.9","E11.65","M25.552","R26.89","M79.10","F41.9","M79.7","S01.111A","S01.81XA","W01.10XA","Y93.01","Y92.481","R40.2362","R40.2142","R40.2252","S63.501A","S73.101A","M16.0","Z82.49","Z23","S09.90XA","M25.531","M25.551","M54.5","W01.0XXA","Y92.89","Y93.89","Z48.02","S59.901A","G47.00","M25.569"],"date":["2020-10-20","2020-10-20","2021-08-11","2021-01-22","2020-10-20","2020-10-20","2020-10-20","2020-10-20","2020-10-20","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2021-04-22","2021-04-22","2020-09-30","2021-01-19","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-08-11","2021-02-15","2021-08-11","2020-12-30","2020-12-30","2021-04-22","2021-05-03","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-29","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-08-11","2021-04-29","2021-04-22","2021-04-22","2021-04-22","2021-05-03","2021-04-22","2021-08-11","2021-08-11"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","68382013510","LOSARTAN POT","TAB 25MG","","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","378481193","DOXEPIN","TAB 6MG","","Select","Select",""],["","69097042107","CELECOXIB","CAP 200MG","","Select","Select",""],["","23155002401","BUSPIRONE","TAB 10MG","","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","50228035390","PREGABALIN","CAP 100MG","","Select","Select",""],["","781502207","METHYLPRED","TAB 4MG","","Select","Select",""],["","70461012003","FLUAD QUADRI","INJ 0.5ML","","Select","Select",""],["","70377000812","ROSUVASTATIN","TAB 20MG","","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","","Select","Select",""],["","65862020199","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","781502207","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","378050301","BISOPRL\/HCTZ ","TAB 5-6.25MG","90","Select","Select",""],["","69097042107","CELECOXIB ","CAP 200MG","60","Select","Select",""],["","378481193","DOXEPIN ","TAB 6MG","90","Select","Select",""],["","70377000812","ROSUVASTATIN ","TAB 20MG","90","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","90","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","70461012003","FLUAD ","INJ 0.5ML","0.5","Select","Select",""],["","50228035390","PREGABALIN ","100MG","90","Select","Select",""],["","13107005999","APAP\/CODEINE ","300-30MG","12","Select","Select",""],["","23155002401","BUSPIRONE ","10MG","270","Select","Select",""],["","65862020199","LOSARTAN","25MG","30","Select","Select",""],["","00378050301","BISOPRL\/HCTZ","5-6.25MG","90","Select","Select",""],["","70461012003","FLUAD","0.5ML","0.5","Select","Select",""],["","13107005999","APAP\/CODEINE","300-30MG","12","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}