{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRIAN L MAUPIN","gend":0,"add":"915 WINFALL RD ","city":"GLADYS","state":"VA","zip":"24554-9998","dob":"1969-10-31","age":"","mstatus":"","insh":11016166,"cliId":"2NV6EH0HM54","pno":4346657402,"cno":4346657402,"email":"","ename":"","eno":"","pphy":"ADDIS, DANIEL M","ppno":4347917366,"pcpadd":"219 Parker Rd","pcpcity":"Danville ","pcpstate":"VA","pcpzip":245404034,"pcpcounty":"","pcpid":"P0060036","pcpname":"PIEDMONT FAMILY AND OCCUPATIONAL MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"915 WINFALL RD ","madd2":"","madd3":"","mcity":"GLADYS","mstate":"VA","mzip":"24554-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E78.5","Z23","I25.10","I25.2","F51.01","E11.9","Z79.4","M54.5","G89.29","Z12.5","Z00.00"],"date":["2021-06-24","2021-10-11","2021-10-11","2020-10-23","2021-06-24","2021-10-11","2021-06-24","2020-10-23","2020-10-23","2021-01-22","2021-10-11"],"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":[["","50111056101","TRAZODONE","TAB 100MG","","Select","Select",""],["","169643810","LEVEMIR","INJ FLEXTOUC","","Select","Select",""],["","68180051201","LISINOPRIL","TAB 2.5MG","","Select","Select",""],["","591565810","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","8290320119","BD PEN NEEDL","MIS 31GX5MM","","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","","Select","Select",""],["","76385011050","CARVEDILOL","TAB 3.125MG","","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","55111032201","GLIMEPIRIDE","TAB 4MG","","Select","Select",""],["","27241011904","FENOFIBRATE","CAP 134MG","","Select","Select",""],["","76385011050","CARVEDILOL ","TAB 3.125MG","180","Select","Select",""],["","50111056101","TRAZODONE ","TAB 100MG","180","Select","Select",""],["","68180051201","LISINOPRIL ","TAB 2.5MG","90","Select","Select",""],["","55111032201","GLIMEPIRIDE ","TAB 4MG","90","Select","Select",""],["","169643810","LEVEMIR ","INJ FLEXTOUC","15","Select","Select",""],["","591565810","CYCLOBENZAPR ","TAB 10MG","60","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","8290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","27241011904","FENOFIBRATE ","CAP 134MG","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":[[["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":""}]}]}