{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A NODNARBTREBLEH ","gend":0,"add":"            DR DUBDER 519                         ","city":"CASTLEWOOD               ","state":"VA","zip":"24224-9998","dob":"1983-12-09","age":"","mstatus":"","insh":"00111974","cliId":"","pno":"3767282898","cno":"","email":"","ename":"","eno":"","pphy":"YOUSUF, SAMINA","ppno":2767627600,"pcpadd":"17988 HIGHWAY 58,","pcpcity":"CASTLEWOOD","pcpstate":"VA","pcpzip":24224,"pcpcounty":"","pcpid":"","pcpname":"COMMUNITY MEDICAL CARE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"915 REDBUD RD                                     ","madd2":"                                                  ","madd3":"","mcity":"CASTLEWOOD               ","mstate":"VA","mzip":"24224-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E87.1","F41.1","K04.6","F33.0","R56.9","E22.2","E55.9","G40.89","J30.1","H10.31","R03.0","M54.10","L65.9","Z00.00","E78.5","R53.1","J30.89","Z13.83","I10","E87.2","E87.5","Z23","G40.409","E66.09","Z68.30","E66.3","Z68.27","E78.2","Z13.89","Z13.31","E87.0"," "],"date":["2022-12-05","2022-11-14","2020-03-12","2022-08-03","2019-10-01","2022-04-12","2022-04-12","2020-09-28","2019-08-01","2019-11-12","2022-11-14","2021-03-29","2021-03-29","2022-12-05","2021-08-02","2021-03-29","2022-04-13","2022-04-13","2022-04-13","2022-04-12","2022-04-12","2019-10-24","2021-12-06","2022-04-13","2022-04-13","2020-06-05","2020-06-05","2022-11-14","2022-04-13","2022-04-13","2022-08-03","2022-12-05"],"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":[["","42806014448","DEMECLOCYCL","TAB 300MG","60","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","23155002405","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","67877019705","AMLODIPINE","TAB 2.5MG","90","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0.5","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0.5","Select","Select",""],["","00006409602","VAQTA","INJ 50UNT\/ML","1","Select","Select",""],["","67253090011","ALPRAZOLAM","TAB 0.25MG","6","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","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":""}]}]}