{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES   S HEATH","gend":0,"add":"79 GATEWOOD ROAD                                            ","city":"MARTINSVILLE                  ","state":"VA","zip":"24112-0972","dob":"1959-04-04","age":"","mstatus":"","insh":10056094,"cliId":"","pno":2763361755,"cno":2763361755,"email":"","ename":"","eno":"","pphy":"HUNDLEY, SUSAN D                                            ","ppno":"","pcpadd":"705 Main St","pcpcity":"Danville                      ","pcpstate":"VA","pcpzip":245411803,"pcpcounty":"","pcpid":"P0114250","pcpname":"HEALTH CENTER OF THE PIEDMONT BOYDTON","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"79 GATEWOOD ROAD                                            ","madd2":"                                                            ","madd3":"","mcity":"MARTINSVILLE                  ","mstate":"VA","mzip":"24112-0972","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I48.0","I25.10","I10","E11.9","E78.00","N18.3","Z23","Z12.11","R07.9","R06.00","R07.81","R07.89","Z95.1","Z95.5","K21.9","E78.5","D72.829","I51.7","E66.09","Z82.49","Z79.4","Z79.82","Z79.899","K02.9","R00.1","R79.89","R06.02","D64.9","Z79.02","K08.89","K04.7","Z09","Z79.01","D50.9","Z12.5","F41.9","E78.2"],"date":["2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-09-29","2019-02-05","2021-09-29","2021-09-29","2020-06-23","2019-03-21","2019-03-21","2020-06-23","2019-03-21","2019-03-24","2019-03-24","2019-03-24","2019-03-21","2019-03-21","2019-03-21","2019-03-21","2019-03-21","2019-03-24","2019-03-21","2019-03-24","2019-04-02","2019-03-24","2019-03-24","2019-03-24","2019-03-24","2019-03-24","2019-03-29","2019-03-29","2021-03-18","2020-02-12","2021-09-29","2020-02-12","2021-11-16"],"priorHcc":[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":[["","65862020399","LOSARTAN","100MG","30","Select","Select",""],["","23155010410","METFORMIN","1000MG","60","Select","Select",""],["","16729028715","ROSUVASTATIN","40MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE","40MG","30","Select","Select",""],["","13668010501","ISOSORB","60MG ER","30","Select","Select",""],["","50742062201","NIFEDIPINE","90MG ER","30","Select","Select",""],["","50111043302","TRAZODONE","50MG","30","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","16729021815","CLOPIDOGREL","75MG","30","Select","Select",""],["","00093106101","SOTALOL","80MG","90","Select","Select",""],["","59762330403","NITROGLYCERN","0.4MG","25","Select","Select",""],["","00904759180","FERROUS","325MG","30","Select","Select",""],["","55111058601","AMLOD\/BENAZP","10-40MG","30","Select","Select",""],["","57896070310","IRON","325MG","30","Select","Select",""],["","65862020399","LOSARTAN ","TAB 100MG","30","Select","Select",""],["","23155010410","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","16729028715","ROSUVASTATIN ","TAB 40MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","13668010501","ISOSORB ","TAB 60MG ER","30","Select","Select",""],["","50742062201","NIFEDIPINE ","TAB 90MG ER","30","Select","Select",""],["","50111043302","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","16729021815","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","00093106101","SOTALOL ","TAB 80MG","90","Select","Select",""],["","59762330403","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","00904759180","FERROUS ","TAB 325MG","30","Select","Select",""],["","55111058601","AMLOD\/BENAZP ","CAP 10-40MG","30","Select","Select",""],["","57896070310","IRON ","TAB 325MG","30","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","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}