{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WOODROW J LAFOLLETTE","gend":0,"add":"3212 NORTHWESTERN PIKE  ","city":"WINCHESTER  ","state":"VA","zip":"22603-9998","dob":"1954-07-20","age":"","mstatus":"","insh":11017503,"cliId":"3EX2G16NP88","pno":5408778022,"cno":5408778022,"email":"","ename":"","eno":"","pphy":"AGYEIWAAH, MAVIS A","ppno":5405365400,"pcpadd":"5060 Valley View Blvd NW","pcpcity":"Roanoke  ","pcpstate":"VA","pcpzip":240122038,"pcpcounty":"","pcpid":"P0150882","pcpname":"VALLEY HEALTH WINCHESTER FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"3212 NORTHWESTERN PIKE  ","madd2":"","madd3":"","mcity":"WINCHESTER  ","mstate":"VA","mzip":"22603-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C61","N43.3","R31.9","E11.40","F12.90","E53.8","M15.9","R31.0","F17.200","Z85.46","I10","E78.2","Z28.21","Z01.818","Z23","R26.81","J45.20","R17","R16.0","G89.29","J45.909","E78.5","Z79.899","Z79.84","Z98.890","R60.0","Z48.816","R29.6","R15.9","R19.7","R29.898","M47.26","T14.8XXA","Z12.11","B35.1","M48.02","R26.9","M48.061","M43.02","M51.24","L72.3","Z72.0","Z87.891","Z12.2","Z59.9"],"date":["2021-07-21","2021-07-21","2021-03-12","2021-10-21","2021-03-18","2021-05-27","2021-07-28","2021-03-18","2021-04-15","2021-04-15","2021-05-27","2021-03-18","2021-07-28","2021-04-12","2021-10-21","2021-05-05","2021-03-29","2021-10-21","2021-03-29","2021-04-15","2021-05-16","2021-04-15","2021-04-15","2021-04-15","2021-06-16","2021-05-05","2021-05-27","2021-10-21","2021-06-16","2021-06-16","2021-10-21","2021-10-21","2021-06-16","2021-06-16","2021-07-28","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-05-16","2021-10-21","2021-10-21","2021-10-21"],"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":[["","53885000810","ONETOUCH DEL","MIS PLUS 33G","","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","","Select","Select",""],["","53885000810","ONETOUCH ","MIS PLUS 33G","100","Select","Select",""],["","63304082990","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","69315011610","FUROSEMIDE ","TAB 20MG","90","Select","Select",""],["","69315015501","HYDROCHLOROT ","TAB 12.5MG","30","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","28","Select","Select",""],["","832532511","POT  CL MICRO","20MEQ ER","30","Select","Select",""],["","00006011231","JANUVIA ","50MG","30","Select","Select",""],["","53885000810","ONETOUCH","PLUS 33G","100","Select","Select",""],["","63304082990","ATORVASTATIN","40MG","90","Select","Select",""],["","00832532511","POT CL MICRO","20MEQ ER","30","Select","Select",""],["","00006011231","JANUVIA","50MG","30","Select","Select",""],["","69315015501","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","69315011610","FUROSEMIDE","20MG","90","Select","Select",""],["","67877026430","DULOXETINE","30MG","90","Select","Select",""],["","27241009990","DULOXETINE ","CAP 60MG","90","Select","Select",""],["","16729000316","GLIMEPIRIDE ","TAB 4MG","180","Select","Select",""],["","45802004935","TRIAMCINOLON ","OIN 0.005","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":[[["Yes","Select","",false,""],["Yes","Select","",false,""],["Yes","Select","",false,""],["Yes","Select","",false,""],["No","Select","",false,""],["Yes","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":""}]}]}