{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALEXANDER C HANNER","gend":0,"add":"19312 WHITE OAK RD","city":"SUTHERLAND  ","state":"VA","zip":"23885-9998","dob":"1986-07-01","age":"","mstatus":"","insh":11017620,"cliId":"1PX3R47YQ09","pno":8042658708,"cno":2409946369,"email":"","ename":"","eno":"","pphy":"ENDE, MARK  ","ppno":8047338771,"pcpadd":"121 S Market St","pcpcity":"Petersburg  ","pcpstate":"VA","pcpzip":238034217,"pcpcounty":"","pcpid":"P0060267","pcpname":"ENDE MEDICAL PRACTICE LLP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"1425   HANOVER STREET","add3":"","madd1":"19312 WHITE OAK RD","madd2":"1425   HANOVER STREET","madd3":"","mcity":"SUTHERLAND  ","mstate":"VA","mzip":"23885-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.9","F20.0","M79.644","M79.89","F25.1","F25.9","L27.1","R21","T36.1X5A","T36.8X5A","Z86.19"],"date":["2021-11-15","2021-10-26","2021-09-08","2021-09-08","2021-10-24","2021-11-20","2021-09-06","2021-09-06","2021-09-06","2021-09-06","2021-09-06"],"priorHcc":[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":[["","378145001","LITHIUM CARB","TAB 450MG ER","","Select","Select",""],["","68382080505","TRAZODONE","TAB 50MG","","Select","Select",""],["","70436005902","BUPROPION","TAB 150MG SR","","Select","Select",""],["","527328143","LEVOTHYROXIN","TAB 50MCG","","Select","Select",""],["","33342007215","OLANZAPINE","TAB 20MG","","Select","Select",""],["","456120230","LINZESS","CAP 290MCG","","Select","Select",""],["","70436005902","BUPROPION ","TAB 150MG SR","60","Select","Select",""],["","527328143","LEVOTHYROXIN ","TAB 50MCG","30","Select","Select",""],["","456120230","LINZESS ","CAP 290MCG","30","Select","Select",""],["","378145001","LITHIUM ","TAB 450MG ER","60","Select","Select",""],["","33342007215","OLANZAPINE ","TAB 20MG","30","Select","Select",""],["","68382080505","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","62332002790","LOSARTAN","25MG","30","Select","Select",""],["","68462022401","LITHIUM","450MG ER","60","Select","Select",""],["","51672130601","ALCLOMETASON","0.05%","15","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","20","Select","Select",""],["","62332002790","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","20","Select","Select",""],["","51672130601","ALCLOMETASON ","CRE 0.0005","15","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":""}]}]}