{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHIRLEY GRAY","gend":1,"add":"176 ROGERS AVE APT 18","city":"LEBANON  ","state":"VA","zip":"24266-9998","dob":"1952-02-22","age":"","mstatus":"","insh":11017151,"cliId":"5G15NM2QR53","pno":2762103307,"cno":2762820915,"email":"","ename":"","eno":"","pphy":"PHILLIPS, PAUL A  ","ppno":2768893700,"pcpadd":"16431 Wise St","pcpcity":"Saint Paul  ","pcpstate":"VA","pcpzip":242833537,"pcpcounty":"","pcpid":"P9058876","pcpname":"MSMG FP ST PA","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"176 ROGERS AVE APT 18","madd2":"","madd3":"","mcity":"LEBANON  ","mstate":"VA","mzip":"24266-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["G47.00","K59.00","Z79.899","E66.3","R06.02","R11.0","F41.9","R00.2","I10","E03.9","K21.9","E78.5","F32.9","Z79.891","R11.2","R19.7","E07.9","F41.0","N95.0","R39.9","M17.0","Z12.31","Z13.820","R10.84","Z12.39","R10.9","Z68.29","F33.0","M17.11","M17.12","R07.9","R07.89","E66.9","S02.5XXA","Z00.00","Z87.448","M25.562","M54.5","G62.9","S60.212A","S60.211A","S60.811A","X58.XXXA","M54.9","M79.674","S69.90XA","M25.532","M25.531","Y35.893A","M79.642","M79.641","R45.1","Z87.891","Z53.21","B07.0"],"date":["2021-02-09","2021-10-13","2021-10-13","2021-10-13","2021-02-24","2021-02-24","2021-08-13","2021-02-24","2021-10-13","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-01-07","2021-03-09","2021-07-13","2021-03-08","2021-05-05","2021-04-07","2021-04-07","2021-10-13","2021-05-03","2021-04-09","2021-05-03","2021-05-03","2021-05-03","2021-10-13","2021-05-05","2021-04-09","2021-04-09","2021-08-04","2021-08-04","2021-01-07","2021-01-07","2021-01-07","2021-01-07","2021-01-07","2021-01-07","2021-01-07","2021-08-01","2021-08-01","2021-08-01","2021-08-01","2021-08-13","2021-08-13","2021-08-01","2021-08-01","2021-08-01","2021-08-01","2021-08-01","2021-08-01","2021-08-01","2021-08-01","2021-08-04","2021-08-13"],"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":[["","69238183107","LEVOTHYROXIN","TAB 50MCG","","Select","Select",""],["","16729044315","BUPROPN HCL","TAB 150MG XL","","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","","Select","Select",""],["","23155050105","HYDROXYZ HCL","TAB 25MG","","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","378395105","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","406012305","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","68462012605","GABAPENTIN","TAB 600MG","","Select","Select",""],["","65862016001","ZOLPIDEM","TAB 10MG","","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","115180301","HYDROXYZ PAM","CAP 25MG","","Select","Select",""],["","69315090401","LORAZEPAM","TAB 0.5MG","","Select","Select",""],["","65862048901","QUETIAPINE","TAB 25MG","","Select","Select",""],["","68462010805","TOPIRAMATE","TAB 25MG","","Select","Select",""],["","16729044315","BUPROPN ","TAB 150MG XL","90","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","68462039710","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","69238183107","LEVOTHYROXIN ","TAB 50MCG","90","Select","Select",""],["","23155050105","HYDROXYZ ","TAB 25MG","90","Select","Select",""],["","65862048901","QUETIAPINE ","TAB 25MG","60","Select","Select",""],["","68462010805","TOPIRAMATE ","TAB 25MG","30","Select","Select",""],["","69315090401","LORAZEPAM ","TAB 0.5MG","5","Select","Select",""],["","378395105","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","30","Select","Select",""],["","68462012605","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","406012305","HYDROCO\/APAP ","TAB 5-325MG","90","Select","Select",""],["","65862016001","ZOLPIDEM ","TAB 10MG","30","Select","Select",""],["","71921017209","VENLAFAXINE ","37.5 ER","30","Select","Select",""],["","16729044315","BUPROPN","150MG XL","90","Select","Select",""],["","71921017209","VENLAFAXINE","37.5 ER","30","Select","Select",""],["","00115180401","HYDROXYZ","50MG","30","Select","Select",""],["","52817033010","CYCLOBENZAPR","5MG","60","Select","Select",""],["","63304007601","POT CHLORIDE","10MEQ ER","90","Select","Select",""],["","43547039950","CYCLOBENZAPR ","TAB 5MG","60","Select","Select",""],["","63304007601","POT  CHLORIDE","TAB 10MEQ ER","90","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":""}]}]}