{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HERBERT C DINKINS SR","gend":0,"add":"1925 POWELL SCHOOL ROAD ","city":"BEDFORD  ","state":"VA","zip":"24523-9998","dob":"1934-02-19","age":"","mstatus":"","insh":11018211,"cliId":"1E97PR3DP69","pno":4346100215,"cno":4346100215,"email":"","ename":"","eno":"","pphy":"SAILOR, JANE P ","ppno":5404648700,"pcpadd":"25 Northridge Ln Ste 1","pcpcity":"Lexington","pcpstate":"VA","pcpzip":244503399,"pcpcounty":"","pcpid":"P9058816","pcpname":"MAURY RIVER FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1925 POWELL SCHOOL ROAD ","madd2":"","madd3":"","mcity":"BEDFORD  ","mstate":"VA","mzip":"24523-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.42","G25.81","M16.10","M48.00","M19.011","L97.819","L97.829","E11.22","I12.9","N18.30","D63.1","N25.81","I25.10","G89.4","G56.03","M65.4","M48.10","E11.9","Z51.81","Z79.891","Z78.9","G47.33","M79.604","M79.605","Z79.82","R52","M54.2","M54.12","E11.622","L97.811","L97.822","L97.812","R60.0","I13.10","I87.2","Z79.4","H40.1133","H35.30","E11.3293","M48.02","N35.919","N40.0","N39.0","B87.1","Z79.02","Z79.899","M54.10","E11.21","N18.31","B87.9","I10","Z88.6","Z88.8","N30.20","J98.4","M47.812","M50.323"],"date":["2021-11-30","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-06-28","2021-06-28","2021-08-05","2021-06-28","2021-07-02","2021-10-18","2021-10-28","2021-07-06","2021-08-26","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-07-20","2021-07-20","2021-07-20","2021-10-18","2021-07-19","2021-07-19","2021-07-19","2021-06-29","2021-08-05","2021-08-05","2021-07-30","2021-08-11","2021-08-11","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-07-19","2021-09-24","2021-10-18","2021-10-18"],"priorHcc":[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"","","","","","","",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":[]},{"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":[["","57599157904","FREESTYLE    TES PREC NEO","PREC NEO","100","Select","Select",""],["","168014630","HYDROCORT ","2.50%","28.35","Select","Select",""],["","23320508","LUMIGAN ","0.01%","7.5","Select","Select",""],["","70727049725","RHOPRESSA ","0.02%","2.5","Select","Select",""],["","23921105","COMBIGAN ","0.2\/0.5%","15","Select","Select",""],["","406012405","HYDROCO\/APAP ","7.5-325","90","Select","Select",""],["","31722013130","DUTASTERIDE ","0.5MG","90","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","270","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","180","Select","Select",""],["","00169368512","NOVOLOG ","70\/30","60","Select","Select",""],["","70727049725","RHOPRESSA","0.0002","2.5","Select","Select",""],["","00168014630","HYDROCORT","0.025","28.35","Select","Select",""],["","57599157904","FREESTYLE TES PREC NEO","PREC NEO","100","Select","Select",""],["","00406012405","HYDROCO\/APAP","7.5-325","90","Select","Select",""],["","00023320508","LUMIGAN","0.0001","7.5","Select","Select",""],["","00023921105","COMBIGAN","0.2\/0.5%","15","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","90","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","68382013201","TAMSULOSIN","0.4MG","90","Select","Select",""],["","65862035705","CLOPIDOGREL","75MG","90","Select","Select",""],["","65162010250","GABAPENTIN","300MG","270","Select","Select",""],["","31722013130","DUTASTERIDE","0.5MG","90","Select","Select",""],["","55111012405","ATORVASTATIN","80MG","90","Select","Select",""],["","00169368512","NOVOLOG","70\/30","60","Select","Select",""],["","68180098103","LISINOPRIL","20MG","180","Select","Select",""],["","61314064610","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","73070020011","INSULIN","70\/30","70","Select","Select",""],["","61314064610","NEO\/POLY\/HC ","SOL 1% OTIC","10","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","65862035705","CLOPIDOGREL ","TAB 75MG","90","Select","Select",""],["","00054429731","FUROSEMIDE ","TAB 20MG","90","Select","Select",""],["","68382013201","TAMSULOSIN ","CAP 0.4MG","90","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","73070020011","INSULIN ","INJ 70\/30","70","Select","Select",""],["","55111012405","ATORVASTATIN ","TAB 80MG","90","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","",""],["No","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":""}]}]}