{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DALLAS CRUSENBERRY","gend":0,"add":"338 ELM DRIVE  ","city":"PENNINGTON GAP ","state":"VA","zip":"24277-9998","dob":"1953-04-04","age":"","mstatus":"","insh":11017227,"cliId":"8GK9DQ0DV23","pno":2762077743,"cno":2765461377,"email":"","ename":"","eno":"","pphy":"ALMATARI, ABDULLATIEF","ppno":2765463001,"pcpadd":"127 Health Care Dr,Ste 12","pcpcity":"Pennington Gap ","pcpstate":"VA","pcpzip":242772853,"pcpcounty":"","pcpid":"P0060078","pcpname":"PENNINGTON FAMILY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"338 ELM DRIVE  ","madd2":"","madd3":"","mcity":"PENNINGTON GAP ","mstate":"VA","mzip":"24277-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":[],"date":[],"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":[["","70069009101","AZELASTINE","DRO 0.0005","","Select","Select",""],["","254200801","COLCHICINE","TAB 0.6MG","","Select","Select",""],["","29300013701","CLONIDINE","TAB 0.3MG","","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","31722072610","MONTELUKAST","TAB 10MG","","Select","Select",""],["","52937000120","VASCEPA","CAP 1GM","","Select","Select",""],["","65862059801","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","93720198","PRAVASTATIN","TAB 20MG","","Select","Select",""],["","254200801","COLCHICINE ","TAB 0.6MG","10","Select","Select",""],["","52937000120","VASCEPA ","CAP 1GM","120","Select","Select",""],["","70069009101","AZELASTINE ","DRO 0.0005","6","Select","Select",""],["","29300013701","CLONIDINE ","TAB 0.3MG","60","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","31722072610","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","93720198","PRAVASTATIN ","TAB 20MG","30","Select","Select",""],["","65862059801","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","173068220","VENTOLIN ","AER ","18","Select","Select",""],["","43547035411","LISINOPRIL ","20MG","30","Select","Select",""],["","68180096301","ALBUTEROL ","HFA","8.5","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","43547035411","LISINOPRIL","20MG","30","Select","Select",""],["","68180096301","ALBUTEROL","HFA","8.5","Select","Select",""],["","50228046501","NABUMETONE","500MG","60","Select","Select",""],["","50228046501","NABUMETONE ","TAB 500MG","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":[[["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":""}]}]}