{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BOBBI J PRICE","gend":1,"add":"20921BOYDTON PLANK ROAD ","city":"MC KENNEY","state":"VA","zip":"23872-2645","dob":"1977-04-13","age":"","mstatus":"","insh":11018506,"cliId":"3GJ5M09KE59","pno":8045046402,"cno":8045046402,"email":"","ename":"","eno":"","pphy":"SEQUEIRA, DEBRA M ","ppno":8045615150,"pcpadd":"702 N Main St","pcpcity":"Emporia  ","pcpstate":"VA","pcpzip":238471242,"pcpcounty":"","pcpid":"P0060188","pcpname":"DINWIDDIE MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"LOT 13","add3":"","madd1":"20921BOYDTON PLANK ROAD ","madd2":"LOT 13","madd3":"","mcity":"MC KENNEY","mstate":"VA","mzip":"23872-2645","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.909","M54.30","N39.498","R39.81","F41.1","T50.905A","R00.2","I10","J44.9","K21.9","Z79.82","Z79.899","F41.9","M50.30","M48.02","G95.9","M50.321","M54.2","T42.4X5A","R07.9","R42","E78.5","D64.9","Z23","Z68.31","E66.9","R94.39","S93.412A","M54.12","G99.2","F17.210","G47.30","M51.36","F32.9","M81.0","Z79.1","Z98.1","Z01.812","Z20.822"],"date":["2021-11-06","2021-11-06","2021-11-06","2021-11-06","2021-09-14","2021-09-14","2021-09-14","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-09-14","2021-11-16","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-13","2021-11-16","2021-09-27","2021-09-27","2021-09-27","2021-11-16","2021-09-28","2021-09-15","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-12","2021-11-12"],"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]}},{"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":[["","00378875006","DICLOFENAC","1%","300","Select","Select",""],["","68382041201","OMEPRAZOLE","20MG","90","Select","Select",""],["","45963041806","RANOLAZINE","500MG ER","180","Select","Select",""],["","67877019890","AMLODIPINE","5MG","90","Select","Select",""],["","13668001005","CITALOPRAM","20MG","90","Select","Select",""],["","27808015601","ROSUVASTATIN","10MG","90","Select","Select",""],["","00378459510","METOPROL","25MG ER","90","Select","Select",""],["","67877022305","GABAPENTIN","300MG","270","Select","Select",""],["","45963041806","RANOLAZINE ","TAB 500MG ER","180","Select","Select",""],["","00378875006","DICLOFENAC ","GEL 0.01","300","Select","Select",""],["","13668001005","CITALOPRAM ","TAB 20MG","90","Select","Select",""],["","68382041201","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","67877022305","GABAPENTIN ","CAP 300MG","270","Select","Select",""],["","27808015601","ROSUVASTATIN ","TAB 10MG","90","Select","Select",""],["","00378459510","METOPROL ","TAB 25MG ER","90","Select","Select",""],["","67877019890","AMLODIPINE ","TAB 5MG","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":[[["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":""}]}]}