{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOYCE M DEAN","gend":1,"add":"503 PATTERSON ST  ","city":"PULASKI  ","state":"VA","zip":"24301-9998","dob":"1956-01-18","age":"","mstatus":"","insh":11017497,"cliId":"6JR3MK4AD93","pno":5409807692,"cno":"","email":"","ename":"","eno":"","pphy":"KAATZ, MATTHEW S  ","ppno":5409800550,"pcpadd":"101 1st St NW","pcpcity":"PULASKI  ","pcpstate":"VA","pcpzip":243015603,"pcpcounty":"","pcpid":"P9058766","pcpname":"KAATZ MATTHEW S MD PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"503 PATTERSON ST  ","madd2":"","madd3":"","mcity":"PULASKI  ","mstate":"VA","mzip":"24301-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.00","I10","Z71.6","I71.2","E04.1","I51.7","D35.00","E03.9","R56.9","E78.5","I71.9","J30.2","R53.82","Z79.899","E55.9","M19.90","K21.9","R00.1","D35.02","R07.9","E07.9","J44.9","F17.210","R00.2","I71.4","F17.200","Z79.890","G47.33","G47.19","F41.9","E66.9","Z68.34","G47.36"],"date":["2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-09-10","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-02-05","2021-02-05","2021-10-22","2021-11-16","2021-09-10","2021-09-10","2021-11-16","2021-06-14","2021-07-27","2021-06-29","2021-10-14","2021-10-14","2021-08-10","2021-10-14","2021-06-14","2021-06-14","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04"],"priorHcc":[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":[["","13517011110","PHENOBARB","TAB 32.4MG","","Select","Select",""],["","13107008305","LORAZEPAM","TAB 0.5MG","","Select","Select",""],["","378181510","LEVOTHYROXIN","TAB 150MCG","","Select","Select",""],["","51672411103","PHENYTOIN EX","CAP 100MG","","Select","Select",""],["","50111056101","TRAZODONE","TAB 100MG","","Select","Select",""],["","93770198","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","68382002210","ATENOLOL","TAB 25MG","","Select","Select",""],["","31722054201","INDOMETHACIN","CAP 25MG","","Select","Select",""],["","64679092402","ENALAPRIL","TAB 5MG","","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","64679092402","ENALAPRIL ","TAB 5MG","180","Select","Select",""],["","50111056101","TRAZODONE ","TAB 100MG","30","Select","Select",""],["","13107008305","LORAZEPAM ","TAB 0.5MG","56","Select","Select",""],["","65862069201","PHENYTOIN ","CAP 100MG","360","Select","Select",""],["","13517011110","PHENOBARB ","TAB 32.4MG","120","Select","Select",""],["","93770198","LEVOCETIRIZI ","TAB 5MG","90","Select","Select",""],["","378181510","LEVOTHYROXIN ","TAB 150MCG","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","31722054201","INDOMETHACIN ","CAP 25MG","90","Select","Select",""],["","68382002210","ATENOLOL ","TAB 25MG","45","Select","Select",""],["","70377000315","SIMVASTATIN ","20MG","90","Select","Select",""],["","00456141030","BYSTOLIC ","10MG","90","Select","Select",""],["","70377000315","SIMVASTATIN","20MG","90","Select","Select",""],["","00456141030","BYSTOLIC","10MG","90","Select","Select",""],["","65862069201","PHENYTOIN","100MG","360","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","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","",false,""],["No","Select","",false,""],["No","Select","",false,""],["Yes","Select","",false,""],["No","Select","",false,""],["No","Select","",false,""],["N\/A","Select","",false,""]]]},{"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":""}]}]}