{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"R ERODAEHTRJ NARRUC ","gend":0,"add":" YCNEGER 501 DAOR LOOHCS","city":"AMHERST  ","state":"VA","zip":"24521-9998","dob":"1964-02-11","age":"","mstatus":"","insh":"00119824","cliId":"8GH9FM2CH11","pno":"4943413106","cno":4349460131,"email":"","ename":"","eno":"","pphy":"THOMAS E DOBYNS MD","ppno":4345284312,"pcpadd":"4579 S Amherst Hwy","pcpcity":"MADISON HEIGHTS","pcpstate":"VA","pcpzip":245725343,"pcpcounty":"","pcpid":"P9059102","pcpname":"THOMAS E DOBYNS FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"105 REGENCY SCHOOL ROAD ","madd2":"","madd3":"","mcity":"AMHERST  ","mstate":"VA","mzip":"24521-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R03.0","M10.069","E11.65","E78.01","Z68.24","Z68.25","D12.5","Z12.11","Z80.0","Z86.010","E78.00","K57.30","Z12.5","Z00.00","E78.4","Z23","E78.5","Z87.891","K21.9","M10.00","F33.8","K30","J30.89"],"date":["2020-09-08","2021-09-15","2021-09-15","2021-09-15","2020-09-14","2019-04-12","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2021-09-15","2020-09-08","2018-10-01","2018-10-01","2020-09-14","2020-09-14","2020-09-14","2020-09-14","2020-09-14","2020-09-14","2021-09-15"],"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[["","70710120901","ALLOPURINOL","TAB 100MG","","Select","Select",""],["","5197102","PREVNAR 13","INJ ","","Select","Select",""],["","70377000415","SIMVASTATIN","TAB 40MG","","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","33332031901","AFLURIA QUAD","INJ 2019-20","","Select","Select",""],["","49281042050","FLUZONE QUAD","INJ 2020-21","","Select","Select",""],["","43386009019","GAVILYTE-G ","SOL ","4,000.00","Select","Select",""],["","70710120901","ALLOPURINOL ","TAB 100MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","5197102","PREVNAR ","INJ ","0.5","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","70377000415","SIMVASTATIN ","TAB 40MG","90","Select","Select",""],["","33332031901","AFLURIA ","INJ 2019-20","0.5","Select","Select",""],["","00005197102","PREVNAR","","0.5","Select","Select",""],["","49281042050","FLUZONE","2020-21","0.5","Select","Select",""],["","33332031901","AFLURIA","2019-20","0.5","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","",""],["Yes","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":""}]}]}