{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGEL A ROSARIO DIAZ","gend":0,"add":"55 S SOUTH AVE APT E ","city":"HARRISONBURG","state":"VA","zip":"22801-9998","dob":"1954-12-06","age":"","mstatus":"","insh":11016226,"cliId":"9GR2TV3DC22","pno":5402140552,"cno":5402097572,"email":"","ename":"","eno":"","pphy":"DOMINGUS, JEFF LEWIS ","ppno":5404334913,"pcpadd":"339 NEBO SCHOOL RD","pcpcity":"NEBO  ","pcpstate":"NC","pcpzip":287616848,"pcpcounty":"","pcpid":"P0124711","pcpname":"HARRISONBURG COMMUNITY HEALTH CENTER INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"APT E","add3":"","madd1":"55 S SOUTH AVE APRT E","madd2":"APT E","madd3":"","mcity":"HARRISONBURG","mstate":"VA","mzip":"22801-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E11.9","F32.9","N40.1","R01.1","H91.90","F39","F41.1","G24.01","H90.3","I08.1","H90.5","I34.0","R00.0","R06.00","Z20.828","Z01.818","I25.10","Z79.4","I34.1","I51.7","R06.09","R06.02","I70.0","I51.1","Z91.5","I05.1","R53.83","Z23"],"date":["2021-10-15","2021-10-15","2020-10-30","2021-03-04","2021-10-15","2021-10-15","2021-03-31","2021-10-15","2020-11-12","2020-11-16","2020-12-01","2021-05-10","2020-12-21","2021-05-10","2020-12-17","2020-12-17","2020-12-21","2021-01-06","2020-11-16","2021-05-10","2020-12-21","2020-12-09","2021-05-10","2020-12-21","2021-04-28","2021-05-10","2021-05-10","2021-10-15"],"priorHcc":["","","","","","","","","","","","","","","","","","","",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":[["","70377000215","SIMVASTATIN","TAB 10MG","","Select","Select",""],["","43547034206","RISPERIDONE","TAB 2MG","","Select","Select",""],["","50742061610","METOPROL SUC","TAB 50MG ER","","Select","Select",""],["","57664050083","MIRTAZAPINE","TAB 30MG","","Select","Select",""],["","88221905","LANTUS SOLOS","INJ 100\/ML","","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","","Select","Select",""],["","64679092503","ENALAPRIL","TAB 10MG","","Select","Select",""],["","68382076010","METFORMIN","TAB 1000MG","","Select","Select",""],["","49281012065","FLUZONE HD","INJ PF 20-21","","Select","Select",""],["","50458054160","INVOKAMET","TAB 50-1000","","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","69315013701","BENZTROPINE","TAB 1MG","","Select","Select",""],["","50742061610","METOPROL ","TAB 50MG ER","90","Select","Select",""],["","57664050083","MIRTAZAPINE ","TAB 30MG","30","Select","Select",""],["","43547034206","RISPERIDONE ","TAB 2MG","30","Select","Select",""],["","70377000215","SIMVASTATIN ","TAB 10MG","90","Select","Select",""],["","50458054160","INVOKAMET ","TAB 50-1000","60","Select","Select",""],["","69315013701","BENZTROPINE ","TAB 1MG","60","Select","Select",""],["","88221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","169300715","NOVOLIN ","INJ 70\/30 FP","30","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","51991074890","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","68382076010","METFORMIN ","TAB 1000MG","180","Select","Select",""],["","64679092503","ENALAPRIL ","TAB 10MG","90","Select","Select",""],["","49281012065","FLUZONE ","INJ PF 20-21","0.7","Select","Select",""],["","50742061610","METOPROL","50MG ER","90","Select","Select",""],["","00169300715","NOVOLIN","70\/30 FP","30","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","0.7","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","30","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","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":[[["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":""}]}]}