{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEON CRADDOCK","gend":0,"add":"703 S HERVEY STREET  ","city":"CHASE CITY  ","state":"VA","zip":"23924-9998","dob":"1950-09-05","age":"","mstatus":"","insh":11018131,"cliId":"3G95R12UK56","pno":4349550099,"cno":4342623978,"email":"","ename":"","eno":"","pphy":"KING, BRODERICK D ","ppno":4345751336,"pcpadd":"101 Aubreys Loop,Ste C","pcpcity":"South Boston","pcpstate":"VA","pcpzip":245925054,"pcpcounty":"","pcpid":"P0114250","pcpname":"HEALTH CENTER OF THE PIEDMONT BOYDTON","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"703 S HERVEY STREET  ","madd2":"","madd3":"","mcity":"CHASE CITY  ","mstate":"VA","mzip":"23924-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K57.30","Z86.010"],"date":["2021-09-09","2021-09-09"],"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":[["","70377002911","ATORVASTATIN ","40MG","90","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","90","Select","Select",""],["","24208046325","LATANOPROST ","0.01%","2.5","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","90","Select","Select",""],["","24208046325","LATANOPROST","0.00005","2.5","Select","Select",""],["","10572030201","PEG-3350\/KCL","\/SODIUM","4,000.00","Select","Select",""],["","49281012165","FLUZONE","2021-22","0.7","Select","Select",""],["","10572030201","PEG-3350\/KCL ","SOL \/SODIUM","4,000.00","Select","Select",""],["","49281012165","FLUZONE ","INJ 2021-22","0.7","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","",""],["Yes","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":""}]}]}