{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YTSIRHCHCUORC G","gend":1,"add":"EULB 1262 RD EGDIR","city":"GRETNA","state":"VA","zip":"24557-9998","dob":"1977-07-03","age":"","mstatus":"","insh":"10113564","cliId":"5AR9WJ0EH57","pno":"4943470444","cno":4349444407,"email":"","ename":"","eno":"","pphy":"BURKHOLDER, BRENDEN  ","ppno":"               ","pcpadd":"2900 LAMB CIRCLE","pcpcity":"CHRISTIANSBURG ","pcpstate":"VA","pcpzip":240736344,"pcpcounty":"","pcpid":"P9058480","pcpname":"CENTRA MEDICAL GROUP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2621 BLUERIDGE DR ","madd2":"","madd3":"","mcity":"GRETNA","mstate":"VA","mzip":"24557-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z12.31","R92.1","Z80.3","G24.8","G24.01","Z01.818","Z79.899","G24.9","Z45.49","Z45.42","G25.2","G24.5"],"date":["2021-09-08","2021-09-08","2021-09-08","2021-08-18","2021-08-18","2020-09-17","2020-09-17","2021-11-17","2020-09-18","2020-09-18","2020-09-18","2021-11-17"],"priorHcc":["","","","","","","",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":{"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":[["","47335017923","TETRABENAZIN","TAB 25MG","","Select","Select",""],["","93321301","CLONAZEPAM","TAB 2MG","","Select","Select",""],["","16729021716","SERTRALINE","TAB 100MG","","Select","Select",""],["","527133010","BACLOFEN","TAB 10MG","","Select","Select",""],["","33332042010","AFLURIA QUAD","INJ 2020-21","","Select","Select",""],["","47335017923","TETRABENAZIN ","TAB 25MG","60","Select","Select",""],["","93321301","CLONAZEPAM ","TAB 2MG","90","Select","Select",""],["","59762516003","SERTRALINE ","TAB 100MG","180","Select","Select",""],["","527133010","BACLOFEN ","TAB 10MG","270","Select","Select",""],["","33332042010","AFLURIA ","INJ 2020-21","0.5","Select","Select",""],["","33332042010","AFLURIA","2020-21","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":[[["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":""}]}]}