{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" C NAEJMIHCAOJ","gend":1,"add":"        NUR  SBOCAJ   501                         ","city":"YORKSTOWN                ","state":"VA","zip":"23692-2865","dob":"1945-08-29","age":"","mstatus":"","insh":"00111331","cliId":"","pno":"9740851976","cno":8042430093,"email":"","ename":"","eno":"","pphy":"CLAYTON, MELISSA N","ppno":8047175300,"pcpadd":"11601 IRON BRIDGE RD STE 117,","pcpcity":"Chester","pcpstate":"VA","pcpzip":238311467,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS ST FRANCIS MEDICAL CENTER LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"105   JACOBS  RUN                                 ","madd2":"                                                  ","madd3":"","mcity":"YORKSTOWN                ","mstate":"VA","mzip":"23692-2865","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.41","M41.9","M85.88","Z03.89","Z13.820","M85.851","M47.896","M47.897","M41.86","Z78.0","H40.013","H25.13","E11.9","H16.223","S62.601B","S62.609B","S69.92XA","W26.8XXA","E78.5","I10","Z79.82","S62.631A","S61.211A","S61.219A","Z68.27","E78.00","R73.01","Z68.24","E66.3","M13.0","M85.80","Z68.28","Z79.899","M25.561","M54.16","M25.562","S62.631D","S60.022D","M19.042","M43.16","M46.96","E78.2","R73.03","E83.52","E55.9","Z12.31","Z20.828","K08.109","Z82.49","Z23","Z00.00","R07.89","I20.0","I20.9","R94.31","R00.1","R06.02","R07.9","I25.10","F17.200","R68.89","I21.4","I22.2","Z68.25"," "],"date":["2018-02-08","2018-05-01","2018-02-08","2018-02-08","2018-02-08","2018-06-08","2018-02-08","2018-02-08","2018-02-08","2018-02-08","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2021-03-06","2021-03-06","2021-03-06","2021-03-06","2021-03-06","2021-03-06","2021-03-06","2021-03-23","2021-03-06","2021-03-09","2021-07-13","2021-07-13","2021-07-13","2019-03-20","2018-03-21","2018-03-21","2018-03-21","2018-03-21","2018-03-21","2018-04-12","2018-04-12","2018-04-12","2021-04-20","2021-04-20","2021-04-20","2018-05-01","2018-05-01","2018-10-25","2018-06-08","2018-06-08","2018-06-08","2018-06-08","2021-07-23","2019-09-20","2019-09-20","2020-10-22","2020-12-01","2018-10-25","2018-10-25","2018-10-25","2018-11-06","2018-10-24","2018-10-24","2018-10-24","2018-10-24","2018-10-24","2018-11-06","2018-10-30","2018-11-06","2019-11-26","2021-07-23"],"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":[["","52817036010","METOPROL","TAB 25MG","90","Select","Select",""],["","68180047802","SIMVASTATIN","TAB 10MG","90","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","68382002210","ATENOLOL","TAB 25MG","90","Select","Select",""],["","49281040565","FLUZONE","INJ PF 19-20","0.5","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":""}]}]}