{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HOLLY J TULL","gend":1,"add":"ROBERT  TULL","city":"CHINCOTEAGUE","state":"VA","zip":"23336-2455","dob":"1961-11-25","age":"","mstatus":"","insh":11016888,"cliId":"2K29DE1KD33","pno":7573366084,"cno":7573366084,"email":"","ename":"","eno":"","pphy":"RIOPEL, CATHY S","ppno":7576689222,"pcpadd":"9159 FRANKTOWN ROAD","pcpcity":"FRANKTOWN","pcpstate":"VA","pcpzip":233540000,"pcpcounty":"","pcpid":"P0109959","pcpname":"CHINCOTEAGUE ISLAND COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"6271CHURCH STREET ","add3":"","madd1":"ROBERT  TULL","madd2":"6271CHURCH STREET ","madd3":"","mcity":"CHINCOTEAGUE","mstate":"VA","mzip":"23336-2455","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","E78.5","K21.9","N39.3","Z71.3","R39.81","N31.9","M25.532","M72.2","Z12.11","D12.3","K57.30","K64.8","Z80.0","F79","E66.9","Z68.38","Z79.899","K63.5","H61.21"],"date":["2021-11-01","2021-11-01","2021-04-22","2021-04-22","2021-04-22","2021-10-08","2021-10-08","2021-08-26","2021-07-06","2021-11-02","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-02","2021-11-19"],"priorHcc":[null,null,"","","","","","","",null,null,null,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":[["","67877051210","ATORVASTATIN","CAL CIUM ORAL","","Select","Select",""],["","43547035411","LISINOPRIL","TAB 20MG","","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","172572870","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","67877051210","ATORVASTATIN ","CAL CIUM ORAL","90","Select","Select",""],["","43547035411","LISINOPRIL ","TAB 20MG","180","Select","Select",""],["","23155000810","HYDROCHLOROT ","TAB 25MG","180","Select","Select",""],["","172572870","FAMOTIDINE ","TAB 20MG","180","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","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","",""],["No","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":""}]}]}