{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AV L EIKCAJNEGNIRAEWSN","gend":1,"add":"       DR LLIM RESSUM 727                         ","city":"CROCKETT                 ","state":"VA","zip":"24323-9998","dob":"1981-07-31","age":"","mstatus":"","insh":"00111248","cliId":"","pno":"2967253510","cno":"","email":"","ename":"","eno":"","pphy":"MOSIER, GABRIEL L","ppno":2767838123,"pcpadd":"1616 N MAIN ST STE 3,","pcpcity":"Marion","pcpstate":"VA","pcpzip":243544398,"pcpcounty":"","pcpid":"","pcpname":"SMYTH COUNTY FAMILY PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"727 MUSSER MILL RD                                ","madd2":"                                                  ","madd3":"","mcity":"CROCKETT                 ","mstate":"VA","mzip":"24323-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G43.909","R03.0","S00.93XA","M25.552","M25.562","S09.90XA","W17.81XA","S40.022A","S80.12XA","F17.210","Z79.899","S50.12XA","W01.0XXA","S59.902A","M25.522","S79.912A","S49.92XA","M25.512","S89.92XA","Z00.00","J30.9","I10","F17.200","K04.7","G44.329","R51.9","R20.0","K21.9","Z72.89","F32.2","R39.11","B37.2","E55.9","Z86.2","D69.6","N39.41","D47.3","S29.9XXA","W86.8XXA","T75.4XXA","R20.2","D55.9","J32.9","R94.6","R53.83","I88.0","R19.7","R10.84","Z88.0","Z91.041","Z90.49","R10.9","I88.9","Z23","H35.53","J30.89","Z68.38","Z12.4","Z78.9","Z28.9","T78.40XA","Z68.36"," "],"date":["2022-08-08","2021-02-19","2021-03-07","2021-03-07","2021-03-07","2021-03-07","2021-03-07","2021-03-07","2021-03-07","2021-07-16","2022-08-08","2021-03-07","2021-03-07","2021-03-07","2021-03-07","2021-03-07","2021-03-07","2021-03-07","2021-03-07","2020-03-09","2021-03-22","2021-09-17","2021-03-22","2020-04-20","2021-04-22","2021-06-21","2021-04-22","2022-08-08","2021-04-22","2021-11-05","2021-06-21","2021-07-12","2022-08-08","2021-06-21","2021-09-17","2020-07-09","2020-07-09","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-09-17","2019-09-23","2020-10-20","2019-09-23","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-10-20","2022-01-27","2022-01-27","2022-01-27","2022-01-27","2022-01-27","2022-01-27","2022-08-08","2022-08-08","2022-08-08"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00093770198","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","55111029136","SUMATRIPTAN","TAB 25MG","9","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","0.5","Select","Select",""],["","00115165903","PROPRANOLOL","TAB 10MG","15","Select","Select",""],["","68462018135","CLOTRIMAZOLE","CRE 0.01","30","Select","Select",""],["","69584061150","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","00093716356","TOLTERODINE","CAP 2MG ER","30","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","20","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","19515080852","FLULAVAL","INJ 2022-23","0.5","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}