{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARRIE A LANG","gend":1,"add":"18 HATCHER CT. ","city":"FARMVILLE","state":"VA","zip":"23901-9998","dob":"1974-09-20","age":"","mstatus":"","insh":11017305,"cliId":"4X87K80FW54","pno":4348082495,"cno":4345153685,"email":"","ename":"","eno":"","pphy":"VARNER, LAWRENCE CALLIE ","ppno":4343926143,"pcpadd":"400 Longwood Ave","pcpcity":"Farmville","pcpstate":"VA","pcpzip":239011524,"pcpcounty":"","pcpid":"P9443111","pcpname":"WOODLAND FAMILY PRACTICE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 1161 ","madd2":"","madd3":"","mcity":"PAMPLIN  ","mstate":"VA","mzip":"23958-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R40.4","F25.0","F29","F30.9","F17.210","Z79.899","Z88.8","Z20.822","R41.0","R09.02","Z71.1","F31.2","F31.5","G47.33","F10.10","F14.10","F31.9"],"date":["2021-09-12","2021-09-22","2021-03-31","2021-03-31","2021-09-23","2021-09-22","2021-03-31","2021-09-22","2021-09-12","2021-09-12","2021-09-22","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-10-04"],"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":[["","186037220","SYMBICORT","AER 80-4.5","","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","","Select","Select",""],["","143312601","DICYCLOMINE","CAP 10MG","","Select","Select",""],["","10147095303","PALIPERIDONE","TAB ER 6MG","","Select","Select",""],["","186037220","SYMBICORT ","AER 80-4.5","30.6","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","54","Select","Select",""],["","143312601","DICYCLOMINE ","CAP 10MG","28","Select","Select",""],["","10147095303","PALIPERIDONE ","TAB ER 6MG","30","Select","Select",""],["","13668001005","CITALOPRAM","20MG","30","Select","Select",""],["","62756079888","DIVALPROEX","500MG DR","60","Select","Select",""],["","43547034206","RISPERIDONE","2MG","60","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","43547034206","RISPERIDONE ","TAB 2MG","60","Select","Select",""],["","13668001005","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","62756079888","DIVALPROEX ","TAB 500MG DR","60","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","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","",""],["No","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":""}]}]}