{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CURMAY PRICE","gend":0,"add":"1605 CARTERSVILLE RD ","city":"GOOCHLAND","state":"VA","zip":"23063-9998","dob":"1947-04-28","age":"","mstatus":"","insh":11016832,"cliId":"5MT7MR4GU60","pno":4343948589,"cno":4343948589,"email":"","ename":"","eno":"","pphy":"FRANKLIN JR, WILLIAM A","ppno":7573245674,"pcpadd":"2110 Hartford Rd Ste A","pcpcity":"Hampton  ","pcpstate":"VA","pcpzip":236666600,"pcpcounty":"","pcpid":"P9706049","pcpname":"INTEGRITY HEALTHCARE CORPORATION","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1605 CARTERSVILLE RD ","madd2":"","madd3":"","mcity":"GOOCHLAND","mstate":"VA","mzip":"23063-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["N18.6","Z99.2","N18.9","M20.42","M20.41","L60.0","E11.40","M79.674","M79.675","B35.1","E11.36","H25.12","Z20.822","E78.00","I25.2","Z95.1","Z79.84","Z87.891","Z83.3","H25.813","E11.9","H25.811","Z01.818","Z71.89","H26.9","K80.20","R10.817","R10.9","I25.10","I12.9","Z79.899","Z79.82","H25.812","E27.8","I71.4","N26.1","R10.84","K52.9","H25.11","E11.22","I51.9","K21.9","M19.90","N19","N25.81","R11.0","D63.1","Z00.00","Z71.3","B96.89","J01.90","J30.2","T82.898A","T82.858A","Z96.1","H35.371","Z23","H35.81","I10","N18.5","M10.9","D48.5","S76.111A","E11.43","R26.2","H35.351","Z01.810"],"date":["2021-10-01","2021-10-01","2021-08-01","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-09-14","2021-09-14","2021-09-14","2021-02-11","2021-01-18","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-01-12","2021-01-12","2021-08-17","2021-02-15","2021-11-22","2021-03-09","2021-01-15","2021-01-19","2021-01-16","2021-01-16","2021-08-17","2021-02-11","2021-01-16","2021-02-11","2021-01-18","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-02-15","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-10-19","2021-09-01","2021-07-02","2021-09-01","2021-03-09","2021-03-09","2021-04-05","2021-04-05","2021-04-05","2021-08-20","2021-08-20","2021-07-19","2021-09-24","2021-09-01","2021-07-30","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-09-14","2021-09-14","2021-09-24","2021-11-22"],"priorHcc":[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":[["","50111078751","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","","Select","Select",""],["","378395305","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","","Select","Select",""],["","50111043302","TRAZODONE","TAB 50MG","","Select","Select",""],["","68001024604","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","","Select","Select",""],["","17478071310","OFLOXACIN","DRO 0.3% OP","","Select","Select",""],["","57237000905","MIRTAZAPINE","TAB 30MG","","Select","Select",""],["","24208060203","PROLENSA","SOL 0.0007","","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","378395305","ATORVASTATIN ","TAB 80MG","90","Select","Select",""],["","29300022019","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","57237000905","MIRTAZAPINE ","TAB 30MG","90","Select","Select",""],["","68001024604","ONDANSETRON ","TAB 4MG ODT","30","Select","Select",""],["","60758011905","PREDNISOLONE ","SUS 1% OP","5","Select","Select",""],["","50111043302","TRAZODONE ","TAB 50MG","180","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","21","Select","Select",""],["","17478071310","OFLOXACIN ","DRO 0.3% OP","5","Select","Select",""],["","24208060203","PROLENSA ","SOL 0.0007","3","Select","Select",""],["","00065175007","ILEVRO","0.3% OP","1.7","Select","Select",""],["","59922063101","AURYXIA","210MG","810","Select","Select",""],["","55111017915","TIZANIDINE","2MG","60","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","32","Select","Select",""],["","00065175007","ILEVRO ","DRO 0.3% OP","1.7","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","32","Select","Select",""],["","59922063101","AURYXIA ","TAB 210MG","810","Select","Select",""],["","55111017915","TIZANIDINE ","TAB 2MG","60","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":""}]}]}