{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FAY FELLOWS","gend":1,"add":"2155 N 29TH ST","city":"RICHMOND                      ","state":"VA","zip":"23223-9998","dob":"1948-01-15","age":"","mstatus":"","insh":11017245,"cliId":"3F15FQ7VH95","pno":8049714356,"cno":8049714356,"email":"","ename":"","eno":"","pphy":"AYALA-SIMS, VERONICA A","ppno":8047800840,"pcpadd":"1300 E MARSHALL STREET,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":232985054,"pcpcounty":"","pcpid":"P9058308","pcpname":"VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2155 N 29TH ST","madd2":"","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23223-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["N39.0","N20.0","R10.9","R06.02","R60.0","Z82.49","I51.89","E78.5","Z68.43","I50.30","C44.1192","E66.01","H35.30","D31.02","K21.9","Z86.718","Z87.442","Z88.0","Z88.1","Z98.84","Z20.822","M43.16","M47.816","R53.1","R25.2","R29.6","I87.2","M54.9"],"date":["2021-03-29","2021-07-06","2021-03-29","2021-09-07","2021-06-10","2021-06-10","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-09-07","2021-10-26","2021-07-06","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26"],"priorHcc":["",null,"",null,"","","","","","",null,null,null,null,null,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":[["","55111012705","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","55111012705","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","31722052901","TORSEMIDE ","5MG","30","Select","Select",""],["","31722052901","TORSEMIDE","5MG","30","Select","Select",""],["","00006483703","PNEUMOVAX","25\/0.5","0.5","Select","Select",""],["","69543013611","TRAMADOL","50MG","5","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","70461012103","FLUAD","2021-22","0.5","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":""}]}]}