{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA M BRADLEY","gend":1,"add":"2004 WAKEFIELD AVE","city":"COLONIAL HEIGHTS  ","state":"VA","zip":"23834-9998","dob":"1971-05-01","age":"","mstatus":"","insh":11016031,"cliId":"7X12K83CD21","pno":8045202307,"cno":"","email":"","ename":"","eno":"","pphy":"AHMED, IRSHAD  ","ppno":8045240524,"pcpadd":"2801 Boulevard Ste B","pcpcity":"Colonial Heights  ","pcpstate":"VA","pcpzip":238342323,"pcpcounty":"","pcpid":"P0060025","pcpname":"COLONIAL MEDCARE PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 158  ","madd2":"","madd3":"","mcity":"COLONIAL HEIGHTS  ","mstate":"VA","mzip":"23834-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R13.10","I10","R00.0","Z79.899","E66.9","Z68.35"],"date":["2020-09-09","2021-09-10","2021-09-10","2021-09-10","2021-03-12","2021-09-10"],"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":[["","65862085901","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","","Select","Select",""],["","68180051703","LISINOPRIL","TAB 40MG","","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","45963067711","METOPROL SUC","TAB 100MG ER","","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","40","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","90","Select","Select",""],["","68180051703","LISINOPRIL ","TAB 40MG","90","Select","Select",""],["","45963067711","METOPROL ","TAB 100MG ER","90","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","40","Select","Select",""],["","45963067711","METOPROL","100MG ER","90","Select","Select",""],["","65162043606","DICLO\/MISOPR","50-0.2MG","30","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","65162043606","DICLO\/MISOPR ","TAB 50-0.2MG","30","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":""}]}]}