{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"J NEBURNOSKCA","gend":0,"add":"            3301 XOB .O.P                         ","city":"ORANGE                   ","state":"VA","zip":"22960-9998","dob":"1942-03-13","age":"","mstatus":"","insh":"00113120","cliId":"","pno":"7604524112","cno":"","email":"","ename":"","eno":"","pphy":"FLICKINGER, TABOR E","ppno":5406613025,"pcpadd":"661 UNIVERSITY LN STE A,STE B","pcpcity":"Orange","pcpstate":"VA","pcpzip":229602243,"pcpcounty":"","pcpid":"","pcpname":"UNIVERSITY PHYSICIAN ORANGE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"P.O. BOX 1033                                     ","madd2":"                                                  ","madd3":"","mcity":"ORANGE                   ","mstate":"VA","mzip":"22960-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J98.11","R91.8","K22.0","K80.20","K22.9","R63.4","K21.9","E55.9","E87.6","E43","H53.8","R68.89","M80.00XA","Z23","R51.9","R90.82","G93.89","F03.90","I69.90","G30.9","H40.023","H25.813","E46","J47.9","R91.1","H40.1131","T17.490A","R13.10","E53.8","E03.9","G43.909","R93.0","I67.82","R41.82","D64.9","R41.3","G44.89","H40.1134","H40.053","H35.373","H40.89","H40.20X0","H25.13","H40.1133"," "],"date":["2019-01-11","2020-01-27","2020-01-27","2019-01-11","2019-01-11","2019-01-18","2020-01-27","2021-04-19","2020-02-21","2020-01-27","2020-10-09","2020-10-09","2019-02-07","2020-01-27","2020-10-09","2020-10-09","2020-10-09","2021-05-19","2021-05-19","2021-05-19","2021-09-28","2022-08-30","2018-12-27","2019-09-26","2019-09-26","2021-10-05","2019-02-13","2019-02-13","2021-04-19","2021-04-19","2020-10-09","2020-10-09","2020-10-09","2020-02-21","2020-02-21","2020-02-21","2020-02-21","2022-09-19","2022-09-19","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11"],"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":[["","59651000305","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","70436000406","GALANTAMINE","TAB 4MG","60","Select","Select",""],["","24208046325","LATANOPROST","SOL 0.00005","2.5","Select","Select",""],["","23155028801","ACETAZOLAMID","TAB 250MG","90","Select","Select",""],["","50383023310","DORZOL\/TIMOL","SOL 22.3-6.8","10","Select","Select",""],["","00023932105","ALPHAGAN","SOL 0.001","15","Select","Select",""],["","00603154258","POT  CHLORIDE","SOL 0.1","450","Select","Select",""],["","66758019001","KLOR-CON","TAB 20MEQ ER","14","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":""}]}]}