{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDA E DUDLEY","gend":1,"add":"764 N Commerce Ave","city":"Waynesboro  ","state":"VA","zip":"22980-2836","dob":"1948-11-20","age":"","mstatus":"","insh":11016047,"cliId":"2R96Q12YF42","pno":5402362758,"cno":5402362758,"email":"","ename":"","eno":"","pphy":"ALFORD, MARSHA A  ","ppno":"               ","pcpadd":"116 LUCY LANE","pcpcity":"WAYNESBORO  ","pcpstate":"VA","pcpzip":229803275,"pcpcounty":"","pcpid":"P9058325","pcpname":"AH CONVENIENT CARE CLINIC WAYNESBORO","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"764 N Commerce Ave","madd2":"","madd3":"","mcity":"Waynesboro  ","mstate":"VA","mzip":"22980-2836","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R69","M62.9","N20.0","R10.9","I12.9","N18.4","Z79.899","Z88.6","Z88.1","Z88.5","Z88.8","Z91.041","Z87.442","S81.811A","W45.8XXA","L03.115","I10","M79.604","M79.89","S81.811D","L53.8","R22.41","M79.661","W22.8XXD","L08.9","F32.9","Z23","R39.81","R11.0","N17.9","Z90.49","Z90.710","Z90.89","N23","R10.32","R11.10","J20.9","Z20.828","M54.5","R19.5","Z20.822","R35.0","M25.562","M12.9","N18.31","E55.9","E53.8","I87.2","F41.1","E03.9","G89.4","R07.81","S29.9XXA","X58.XXXA","Z79.891","G89.29","R30.0","I16.0","R51.9","R22.43","R60.0","H25.13","H25.013","R15.1","M81.0","N39.0","N18.9","I16.1","N18.30","M51.37","M54.2","G47.09","R07.9","R25.2","Z86.2","F43.20","R23.8","M25.512","M46.1","M70.61","R06.09"],"date":["2021-10-01","2021-11-09","2020-11-02","2021-08-06","2021-08-05","2020-09-25","2021-08-24","2021-08-24","2021-08-24","2021-08-05","2021-08-24","2021-08-24","2021-08-05","2020-09-25","2020-09-14","2021-10-14","2021-11-18","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2021-11-18","2020-09-25","2021-11-17","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2021-08-05","2020-11-02","2020-11-11","2021-02-01","2021-07-01","2021-03-05","2021-03-05","2021-04-26","2021-04-26","2021-07-01","2021-07-01","2021-10-21","2021-10-28","2021-07-01","2021-07-01","2021-10-21","2021-07-01","2021-05-31","2021-05-31","2021-05-31","2021-05-31","2021-06-02","2021-08-09","2021-10-14","2021-08-24","2021-08-24","2021-08-24","2021-04-09","2021-04-09","2021-07-01","2021-07-01","2021-08-05","2021-08-05","2021-08-24","2021-09-02","2021-10-28","2021-09-02","2021-11-18","2021-11-02","2021-10-14","2021-10-21","2021-10-14","2021-10-14","2021-10-19","2021-10-19","2021-10-19","2021-11-02"],"priorHcc":["",null,"","","","","","","","","","","","","","",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":[["","50742061610","METOPROL SUC","TAB 50MG ER","","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","","Select","Select",""],["","68382003516","VENLAFAXINE","CAP 75MG ER","","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","13668000805","ZOLPIDEM ","TAB 10MG","30","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","68382003416","VENLAFAXINE ","CAP 37.5 ER","60","Select","Select",""],["","50742061610","METOPROL ","TAB 50MG ER","30","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","7","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","90","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","28","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","00143992801","CIPROFLOXACN","500MG","14","Select","Select",""],["","50742061610","METOPROL","50MG ER","30","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","65162083809","VALSARTAN","80MG","90","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","16729018201","HYDROCHLOROT ","TAB 12.5MG","30","Select","Select",""],["","53746051101","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","65162083809","VALSARTAN ","TAB 80MG","90","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","",""],["Yes","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":""}]}]}