{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARTHA J SHELTON","gend":1,"add":"323 12TH STREET","city":"COLONIAL BEACH ","state":"VA","zip":"22443-1558","dob":"1964-05-12","age":"","mstatus":"","insh":11017071,"cliId":"9NK7W22ET31","pno":5406842961,"cno":5407068859,"email":"","ename":"","eno":"","pphy":"COOK, WILSON","ppno":5403745200,"pcpadd":"10502 Rhoads Dr","pcpcity":"Fredericksburg ","pcpstate":"VA","pcpzip":224077787,"pcpcounty":"","pcpid":"P0114251","pcpname":"RAPPAHANNOCK FAMILY PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APARTMENT 4 ","add3":"","madd1":"323 12TH STREET","madd2":"APARTMENT 4 ","madd3":"","mcity":"COLONIAL BEACH ","mstate":"VA","mzip":"22443-1558","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F31.9","E11.65","E11.42","E03.9","R69","F31.31","E11.9","R10.31","R10.11","R11.0","E78.2","I10","N61.0","C50.919","M19.032","D24.1","R92.2","Z80.3","M25.532","I25.10","I12.9","E11.22","N18.9","J44.9","H91.90","H40.9","I25.2","F43.10","E11.40","F17.210","E66.01","Z86.711","Z85.038","Z85.6","Z86.16","N64.4","Z68.41","R53.81","N63.0","R09.81","R53.82","Z20.822","Z91.89"],"date":["2021-10-26","2021-06-24","2021-06-24","2021-06-24","2021-06-10","2021-04-05","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-06-24","2021-06-24","2021-09-15","2021-07-12","2021-07-04","2021-07-12","2021-07-20","2021-09-13","2021-07-04","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-08-10","2021-07-10","2021-07-10","2021-07-12","2021-07-10","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-10","2021-07-12","2021-07-12","2021-07-12","2021-07-26","2021-07-20","2021-09-09","2021-09-09","2021-11-08","2021-09-15"],"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":[["","54040013","DESVENLAFAX","TAB 50MG ER","","Select","Select",""],["","62175013643","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","597015390","JARDIANCE","TAB 25MG","","Select","Select",""],["","68180097403","LEVOTHYROXIN","TAB 175MCG","","Select","Select",""],["","8290320122","BD PEN NEEDL","MIS 32GX4MM","","Select","Select",""],["","23155010205","METFORMIN","TAB 500MG","","Select","Select",""],["","16714098801","ROSUVASTATIN","TAB 5MG","","Select","Select",""],["","70436001102","BUPROPN HCL","TAB 300MG XL","","Select","Select",""],["","68382001005","LAMOTRIGINE","TAB 200MG","","Select","Select",""],["","527411837","PROPRANOLOL","CAP 120MG ER","","Select","Select",""],["","2143480","TRULICITY","INJ 1.5\/0.5","","Select","Select",""],["","169633910","NOVOLOG","INJ FLEXPEN","","Select","Select",""],["","88221905","LANTUS SOLOS","INJ 100\/ML","","Select","Select",""],["","65702071110","ACCU-CHEK","TES GUIDE","","Select","Select",""],["","16714008212","HYDROXYZ HCL","TAB 25MG","","Select","Select",""],["","88221905","LANTUS ","INJ 100\/ML","45","Select","Select",""],["","8290320122","BD  PEN NEEDL","MIS 32GX4MM","400","Select","Select",""],["","65702071110","ACCU-CHEK ","TES GUIDE","300","Select","Select",""],["","54040013","DESVENLAFAX ","TAB 50MG ER","30","Select","Select",""],["","10370010150","BUPROPN ","TAB 150MG XL","90","Select","Select",""],["","68180097403","LEVOTHYROXIN ","TAB 175MCG","90","Select","Select",""],["","62175013643","OMEPRAZOLE ","CAP 40MG","180","Select","Select",""],["","597015390","JARDIANCE ","TAB 25MG","90","Select","Select",""],["","169633910","NOVOLOG ","INJ FLEXPEN","30","Select","Select",""],["","2143480","TRULICITY ","INJ 1.5\/0.5","6","Select","Select",""],["","527411837","PROPRANOLOL ","CAP 120MG ER","90","Select","Select",""],["","23155010205","METFORMIN ","TAB 500MG","180","Select","Select",""],["","68382001005","LAMOTRIGINE ","TAB 200MG","90","Select","Select",""],["","16714008212","HYDROXYZ ","TAB 25MG","90","Select","Select",""],["","27808015501","ROSUVASTATIN ","TAB 5MG","90","Select","Select",""],["","59651036105","IBUPROFEN ","600MG","30","Select","Select",""],["","65702073110","ACCU-CHECK ","GUIDE ME","1","Select","Select",""],["","63304069201","CLINDAMYCIN ","150MG","28","Select","Select",""],["","10370010150","BUPROPN","150MG XL","90","Select","Select",""],["","00088221905","LANTUS","100\/ML","45","Select","Select",""],["","00093506105","HYDROXYZ","25MG","90","Select","Select",""],["","59651036105","IBUPROFEN","600MG","30","Select","Select",""],["","63304069201","CLINDAMYCIN","150MG","28","Select","Select",""],["","00143980305","DOXYCYCL","100MG","20","Select","Select",""],["","65702073110","ACCU-CHECK","GUIDE ME","1","Select","Select",""],["","62332025050","DOXYCYC","100MG","28","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","28","Select","Select",""],["","59310057922","PROAIR ","AER ","25.5","Select","Select",""],["","62332025050","DOXYCYC ","CAP 100MG","28","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":""}]}]}