{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELLA L WEEDEN","gend":1,"add":"255 SCUFFLETOWN ROAD","city":"WALKERTON","state":"VA","zip":231772048,"dob":"1943-04-07","age":"","mstatus":"","insh":11017815,"cliId":"9H28V90YA21","pno":8043661037,"cno":"","email":"","ename":"","eno":"","pphy":"LEWIS, AUGUSTINE","ppno":8047396142,"pcpadd":"13540 HULL STREET RD","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":231122107,"pcpcounty":"CHESTERFIELD","pcpid":"P0060052","pcpname":"AYLETT MEDICAL CENTER","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":[],"date":[],"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":[]},{"a":[]}]},{"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":[["","65162059606","ASA\/DIPYRIDA","CAP 25-200MG","","Select","Select",""],["","8290328468","INSULIN SYRG","MIS 0.5\/31G","","Select","Select",""],["","64380073508","HYDRALAZINE","TAB 50MG","","Select","Select",""],["","16714087502","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","16714083201","BUMETANIDE","TAB 1MG","","Select","Select",""],["","43547035611","LISINOPRIL","TAB 40MG","","Select","Select",""],["","29300039810","AMLODIPINE","TAB 10MG","","Select","Select",""],["","16714071503","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","","Select","Select",""],["","42858011830","LIDOCAINE","PAD 0.05","","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}