{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYNTHIA K HALL","gend":1,"add":"30417 SPARTA ROAD ","city":"MILFORD  ","state":"VA","zip":"22514-2854","dob":"1959-01-28","age":"","mstatus":"","insh":11015945,"cliId":"2K74DW5VW92","pno":8046332296,"cno":8046332296,"email":"","ename":"","eno":"","pphy":"BASHORE, RANDALL T","ppno":4345813271,"pcpadd":"2217 Princess Anne St,Ste 100-2","pcpcity":"Fredericksburg ","pcpstate":"VA","pcpzip":224013359,"pcpcounty":"","pcpid":"P0060336","pcpname":"COMMUNITY HEALTH CENTER OF THE RAPPAHANNOCK REGION","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"30417 SPARTA ROAD ","madd2":"","madd3":"","mcity":"MILFORD  ","mstate":"VA","mzip":"22514-2854","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I46.9","I42.8","Z95.810","I34.0","I10","N17.9","Z45.02","Z86.74","I47.2","I42.9","E23.0","Z23","F41.9","E78.5","Z71.89","Z71.3","E23.2","R11.0","G47.00","K21.9"],"date":["2021-09-28","2021-09-28","2021-09-28","2021-01-05","2021-01-05","2021-01-19","2021-06-15","2020-12-01","2021-03-04","2021-09-28","2021-04-29","2021-06-01","2021-06-21","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13"],"priorHcc":[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":[["","47781064690","LEVOTHYROXIN","TAB 75MCG","","Select","Select",""],["","68645057154","CITALOPRAM","TAB 40MG","","Select","Select",""],["","47335078891","DESMOPRESSIN","SPR 0.0001","","Select","Select",""],["","93505698","ATORVASTATIN","TAB 10MG","","Select","Select",""],["","50742061510","METOPROL SUC","TAB 25MG ER","","Select","Select",""],["","64380097106","HYDROCORT","TAB 10MG","","Select","Select",""],["","24208034205","DESMOPRESSIN ","SPR 0.0001","15","Select","Select",""],["","47781064690","LEVOTHYROXIN ","TAB 75MCG","30","Select","Select",""],["","68645057154","CITALOPRAM ","TAB 40MG","90","Select","Select",""],["","64380097106","HYDROCORT ","TAB 10MG","90","Select","Select",""],["","93505698","ATORVASTATIN ","TAB 10MG","90","Select","Select",""],["","16714008310","HYDROXYZ ","TAB 50MG","30","Select","Select",""],["","50742061510","METOPROL ","TAB 25MG ER","180","Select","Select",""],["","68645055154","LISINOPRIL ","5MG","180","Select","Select",""],["","72305007530","EUTHYROX ","75MCG","30","Select","Select",""],["","72305007530","EUTHYROX","75MCG","30","Select","Select",""],["","16714008310","HYDROXYZ","50MG","30","Select","Select",""],["","68645055154","LISINOPRIL","5MG","180","Select","Select",""],["","50742061510","METOPROL","25MG ER","180","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":""}]}]}