{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LILLIAN A BLEDSOE","gend":1,"add":"20 BENTLEY COURT  ","city":"FREDERICKSBURG ","state":"VA","zip":"22408-9998","dob":"1957-08-25","age":"","mstatus":"","insh":11016533,"cliId":"1RM7UG1GA58","pno":5403107873,"cno":5406540141,"email":"","ename":"","eno":"","pphy":"VANGANI, VEENA N  ","ppno":5404236600,"pcpadd":"4604 Spotsylvania Pkwy,Ste 125","pcpcity":"Fredericksburg ","pcpstate":"VA","pcpzip":224087763,"pcpcounty":"","pcpid":"P0157379","pcpname":"SPOTSYLVANIA MULTISPECIALTY GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"20 BENTLEY COURT  ","madd2":"","madd3":"","mcity":"FREDERICKSBURG ","mstate":"VA","mzip":"22408-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M47.816","M47.817","M43.06","M62.830","G62.9","G89.29","Z79.891","I10","E78.5","E11.65","E11.9","N17.2","Z23","R39.81","G81.91","N39.41","J44.1","M54.5","M05.9","M25.50","M25.559","M48.07","R52","E11.42","L30.9","M79.671","M77.00","M19.012","M77.12","J44.9"],"date":["2020-10-06","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2020-10-08","2020-10-06","2021-11-05","2020-10-08","2021-10-27","2021-11-05","2020-10-23","2021-09-13","2021-10-30","2021-10-30","2021-10-30","2021-03-04","2021-11-05","2021-05-03","2021-05-03","2021-07-15","2021-07-15","2021-07-15","2021-09-10","2021-09-10","2021-09-10","2021-09-13","2021-10-05","2021-10-05","2021-11-01"],"priorHcc":["","","","","","","",null,"",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":[["","13668000705","ZOLPIDEM","TAB 5MG","","Select","Select",""],["","597002402","COMBIVENT","AER 20-100","","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA","","Select","Select",""],["","93936401","GLYBURIDE","TAB 5MG","","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","","Select","Select",""],["","76385012810","METFORMIN","TAB 500MG ER","","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","","Select","Select",""],["","597015230","JARDIANCE","TAB 10MG","","Select","Select",""],["","456120130","LINZESS","CAP 145MCG","","Select","Select",""],["","6027731","JANUVIA","TAB 100MG","","Select","Select",""],["","51991074790","DULOXETINE","CAP 30MG","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","31722070190","LOSARTAN POT","TAB 50MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","93727098","PRAVASTATIN","TAB 80MG","","Select","Select",""],["","68308015260","NYSTATIN","POW 100000","","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","","Select","Select",""],["","93936401","GLYBURIDE ","5MG","90","Select","Select",""],["","53885013610","ONETOUCH ","LANCETS","100","Select","Select",""],["","6027731","JANUVIA ","100MG","90","Select","Select",""],["","69097081312","GABAPENTIN ","100MG","90","Select","Select",""],["","597002402","COMBIVENT ","20-100","12","Select","Select",""],["","13668000705","ZOLPIDEM ","5MG","30","Select","Select",""],["","93317431","ALBUTEROL ","E","8.5","Select","Select",""],["","49483060450","IBUPROFEN ","800MG","90","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","90","Select","Select",""],["","76385012810","METFORMIN ","500MG ER","360","Select","Select",""],["","51991074790","DULOXETINE ","30MG","90","Select","Select",""],["","93727098","PRAVASTATIN ","80MG","90","Select","Select",""],["","456120130","LINZESS ","145MCG","30","Select","Select",""],["","597015230","JARDIANCE ","10MG","30","Select","Select",""],["","54327099","FLUTICASONE ","50MCG","48","Select","Select",""],["","31722070190","LOSARTAN ","50MG","90","Select","Select",""],["","68308015260","NYSTATIN ","100000","60","Select","Select",""],["","55111032001","GLIMEPIRIDE ","1MG","90","Select","Select",""],["","31722070190","LOSARTAN","50MG","90","Select","Select",""],["","55111032001","GLIMEPIRIDE","1MG","90","Select","Select",""],["","65162019050","NAPROXEN","500MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","28","Select","Select",""],["","51672127401","BETAMETH","0.05%","30","Select","Select",""],["","69097052444","DICLOFENAC","1%","300","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","300","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","60","Select","Select",""],["","51672127401","BETAMETH ","CRE 0.0005","30","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","28","Select","Select",""],["","00093005805","TRAMADOL ","TAB 50MG","120","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":""}]}]}