{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DIANNA NORDSTROM","gend":1,"add":"201 MILNWOOD VILLAGE LN ","city":"FARMVILLE ","state":"VA","zip":"23901-9998","dob":"1946-10-28","age":"","mstatus":"","insh":11017617,"cliId":"7HH5C56AW72","pno":4344146894,"cno":4344146894,"email":"","ename":"","eno":"","pphy":"PRUITT, DAVID E ","ppno":4343928177,"pcpadd":"3510 Anderson Hwy, Ste A ","pcpcity":"Powhatan","pcpstate":"VA","pcpzip":231395846,"pcpcounty":"","pcpid":"P0124781","pcpname":"CENTRA MEDICAL GROUP SOUTHSIDE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"NUMBER 2","add3":"","madd1":"201 MILNWOOD VILLAGE LN ","madd2":"NUMBER 2","madd3":"","mcity":"FARMVILLE ","mstate":"VA","mzip":"23901-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.23","Z95.810","I25.10","N18.9","E11.9","I50.22","I48.91","I12.9","N18.30","I50.20","M10.9","Z95.0","I51.3","I10","E88.09","D47.2","E85.9","H18.421","H40.033","Z96.1","R91.1","R59.0","I51.7","J90","C34.11","G20","H04.123","E11.3292","E11.21","N18.4","I50.9","R91.8","N18.32","I15.1","R80.9"],"date":["2021-03-17","2021-08-20","2021-07-29","2021-06-03","2021-07-29","2021-06-03","2021-07-29","2021-08-27","2021-04-15","2021-04-15","2021-04-15","2021-06-03","2021-06-03","2021-06-03","2021-06-01","2021-07-29","2021-06-03","2021-07-29","2021-06-28","2021-06-28","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-09-23","2021-07-29","2021-06-28","2021-06-28","2021-08-27","2021-08-27","2021-08-27","2021-08-10","2021-08-27","2021-08-27","2021-08-27"],"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":[["","93505898","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","3089421","ELIQUIS","TAB 5MG","","Select","Select",""],["","78065920","ENTRESTO","TAB 24-26MG","","Select","Select",""],["","50924097110","SOFTCLIX","MIS LANCETS","","Select","Select",""],["","64380072306","CALCITRIOL","CAP 0.25MCG","","Select","Select",""],["","50111091701","TORSEMIDE","TAB 20MG","","Select","Select",""],["","8290320550","BD PEN NEEDL","MIS 32GX5\/32","","Select","Select",""],["","88221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","2879959","HUMALOG ","INJ 100\/ML","15","Select","Select",""],["","93505898","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","8290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","3089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","169633910","NOVOLOG ","INJ FLEXPEN","15","Select","Select",""],["","78065920","ENTRESTO ","TAB 24-26MG","60","Select","Select",""],["","64380072306","CALCITRIOL ","CAP 0.25MCG","90","Select","Select",""],["","50111091701","TORSEMIDE ","TAB 20MG","180","Select","Select",""],["","47781064690","LEVOTHYROXIN ","TAB 75MCG","90","Select","Select",""],["","50924097110","SOFTCLIX ","MIS LANCETS","100","Select","Select",""],["","16714004107","ALLOPURINOL ","TAB 100MG","90","Select","Select",""],["","65702040810","ACCU-CHEK ","AVIVA PL","100","Select","Select",""],["","70069013101","TOBRAMYCIN ","0.3% OP","5","Select","Select",""],["","65702040810","ACCU-CHEK","AVIVA PL","100","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","16714004107","ALLOPURINOL","100MG","90","Select","Select",""],["","00002879959","HUMALOG","100\/ML","15","Select","Select",""],["","00169633910","NOVOLOG","FLEXPEN","15","Select","Select",""],["","60758011905","PREDNISOLONE","1% OP","5","Select","Select",""],["","47781064690","LEVOTHYROXIN","75MCG","90","Select","Select",""],["","70069013101","TOBRAMYCIN","0.3% OP","5","Select","Select",""],["","68382009305","CARVEDILOL","6.25MG","180","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","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}