{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"H LRAENAMFFU","gend":0,"add":"TLUB 03DAOR RE","city":"FREDERICKSBURG","state":"VA","zip":"22405-2332","dob":"1957-07-26","age":"","mstatus":"","insh":"00113589","cliId":"","pno":"0404536698","cno":"","email":"","ename":"","eno":"","pphy":"ALEXANDER, DAWN","ppno":5407109100,"pcpadd":"231 Garrisonville Rd, Ste 101","pcpcity":"Stafford","pcpstate":"VA","pcpzip":225541604,"pcpcounty":"","pcpid":"","pcpname":"RAPPAHANNOCK FAMILY PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"30 BULTER ROAD","madd2":"","madd3":"","mcity":"FREDERICKSBURG","mstate":"VA","mzip":"22405-2332","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.1","F17.200","G40.909","E87.2","I10","J44.9","J96.11","E78.5","R41.3","Z12.11","R74.8","R25.1","E55.9","J96.21","F17.210","Z99.81","Z85.828","R06.02","R09.02","R56.9","R06.00","J98.4","R69","R26.89","R25.2","R73.01"],"date":["2020-05-24","2020-05-19","2021-08-12","2020-01-01","2020-01-01","2021-07-30","2020-05-11","2021-07-30","2021-08-12","2021-04-09","2021-07-30","2020-05-11","2021-07-30","2020-05-24","2020-05-24","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-20","2020-05-19","2020-05-19","2020-05-24","2021-07-30","2021-07-30","2021-07-30"],"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":[["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","76204060030","IPRATROPIUM\/","SOL ALBUTER","270","Select","Select",""],["","16571068101","CARBAMAZEPIN","TAB 200MG ER","180","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","57664080818","PHENYTOIN","CAP 100MG","270","Select","Select",""],["","57237009960","CEFDINIR","CAP 300MG","10","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","00173069500","ADVAIR","AER 100\/50","60","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","6","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}