{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM M RADFORD","gend":0,"add":"113 JONEZ DR","city":"AMHERST","state":"VA","zip":245219999,"dob":"1930-05-02","age":"","mstatus":"","insh":11017065,"cliId":"9A12MH0TJ07","pno":4349460097,"cno":"","email":"","ename":"","eno":"","pphy":"CROOK, MEAGHAN TERESE","ppno":2073237484,"pcpadd":"115 AMBRIAR PLZ","pcpcity":"AMHERST","pcpstate":"VA","pcpzip":245214741,"pcpcounty":"","pcpid":"P9307282","pcpname":"CENTRA MEDICAL GROUP","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"WESTERN\/CHARLOTTESVILLE","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["N40.1","R39.9","R33.9","E11.22","E11.9","I12.9","I10","N18.9","Z78.9","N39.0","R15.9","R32"],"date":["2021-03-03","2021-04-28","2021-03-03","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-03-04","2021-04-28","2021-05-12","2021-05-12"],"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":[["","55111032101","GLIMEPIRIDE","TAB 2MG","","Select","Select",""],["","378021610","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","33342004810","IRBESARTAN","TAB 150MG","","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","76385011250","CARVEDILOL","TAB 12.5MG","","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","","Select","Select",""],["","49281042050","FLUZONE QUAD","INJ 2020-21","","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","55111032101","GLIMEPIRIDE ","TAB 2MG","90","Select","Select",""],["","33342004810","IRBESARTAN ","TAB 150MG","90","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","378021610","FUROSEMIDE ","TAB 40MG","90","Select","Select",""],["","53885013610","ONETOUCH ","MIS LANCETS","100","Select","Select",""],["","23155000810","HYDROCHLOROT ","TAB 25MG","90","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","76385011250","CARVEDILOL ","TAB 12.5MG","180","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","43547026910","ROPINIROLE ","0.5MG","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}