{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MADGE D KELLUM","gend":1,"add":"321 MOSQUITO POINT ROAD","city":"WHITE STONE","state":"VA","zip":225782900,"dob":"1953-07-29","age":"","mstatus":"","insh":11017839,"cliId":"7NR1M99FJ00","pno":8046998617,"cno":8044503183,"email":"","ename":"","eno":"","pphy":"ASHWORTH, JOEL THOMAS","ppno":8044352651,"pcpadd":"9460 Amberdale Dr","pcpcity":"North Chesterfield","pcpstate":"VA","pcpzip":232361259,"pcpcounty":"","pcpid":"P0143479","pcpname":"BON SECOURS KILMARNOCK PRIMARY CARE","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"CENTRAL","aligned":"N","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":[["","51672400201","NORTRIPTYLIN","CAP 25MG","","Select","Select",""],["","43547040611","CLONAZEPAM","TAB 0.5MG","","Select","Select",""],["","62756079813","DIVALPROEX","TAB 500MG DR","","Select","Select",""],["","55111018010","TIZANIDINE","TAB 4MG","","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","68382080605","TRAZODONE","TAB 100MG","","Select","Select",""],["","31722057310","ESOMEPRA MAG","CAP 40MG DR","","Select","Select",""],["","47781064610","LEVOTHYROXIN","TAB 75MCG","","Select","Select",""],["","378623205","CITALOPRAM","TAB 20MG","","Select","Select",""],["","31722072610","MONTELUKAST","TAB 10MG","","Select","Select",""],["","69097015815","MELOXICAM","TAB 7.5MG","","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","","Select","Select",""],["","13668021605","ARIPIPRAZOLE","TAB 2MG","","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":""}]}]}