{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ATREBORNEDLOB A","gend":1,"add":"      DAOR EDISKOORB 5842                         ","city":"AXTON                    ","state":"VA","zip":"24054-9998","dob":"1965-08-08","age":"","mstatus":"","insh":"00113624","cliId":"","pno":"5243453950","cno":4342509596,"email":"","ename":"","eno":"","pphy":"ALBA, GREGORY J","ppno":4347971383,"pcpadd":"404 AIRPORT DR STE C,","pcpcity":"Danville","pcpstate":"VA","pcpzip":245405196,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"2485 BROOKSIDE ROAD                               ","madd2":"                                                  ","madd3":"","mcity":"AXTON                    ","mstate":"VA","mzip":"24054-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R31.29","F17.200","Z12.12","R82.90","Z12.31","E78.2","I10","E11.9","E55.9","Z23","F41.9","Z12.4","Z01.419","Z11.51","F33.1","E11.65","L72.9","E78.5","F41.1","E11.51","Z12.11","Z11.59","R82.998","R74.8","R73.01","R74.0","H40.023","N92.6","H40.1132","H25.813","B08.1","K76.0","H25.13","H50.15","H53.031","Z79.84","H40.013","H31.113","E66.9","F17.210","F70","H17.9","K02.9","Z68.33","Z79.899","D50.9","J04.0","M79.621","F43.23","H40.1123","H40.1112","H40.003","L30.9","R23.4","B35.1","M70.62","J06.9","B35.3","E66.3","Z68.32","N89.8","M25.551","M16.10","E11.40","M76.821","E66.09","H40.1131"," "],"date":["2021-01-19","2019-01-07","2022-03-14","2021-01-19","2022-03-14","2022-11-15","2022-11-15","2022-09-13","2021-07-14","2022-11-15","2022-11-15","2020-01-13","2021-01-19","2021-01-19","2022-11-22","2022-11-15","2022-01-27","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2019-03-29","2019-03-29","2019-03-29","2019-03-29","2019-04-05","2022-05-04","2019-05-23","2021-07-07","2022-09-07","2019-06-18","2019-07-05","2020-07-15","2020-07-15","2020-07-15","2020-07-15","2020-07-15","2018-08-09","2021-10-20","2018-09-05","2018-09-05","2018-09-05","2018-09-05","2018-09-05","2018-09-05","2018-09-27","2020-10-16","2021-10-21","2021-10-28","2021-11-15","2021-11-15","2020-11-23","2021-11-30","2021-11-30","2022-09-13","2020-12-01","2019-12-11","2022-09-13","2022-03-14","2022-03-14","2022-03-14","2022-04-02","2022-04-02","2022-04-19","2022-04-19","2022-11-15","2022-09-07","2022-11-22"],"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":[["","50924097110","SOFTCLIX","MIS LANCETS","100","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","90","Select","Select",""],["","68382005001","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","31722070290","LOSARTAN","TAB 100MG","90","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","90","Select","Select",""],["","00093585105","ESCITALOPRAM","TAB 10MG","90","Select","Select",""],["","68645048054","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","00006008154","JANUMET","TAB 100-1000","90","Select","Select",""],["","65702040710","ACCU-CHEK","TES AVIVA PL","50","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","5","Select","Select",""],["","49281072110","FLUBLOK","INJ 2021-22","0.5","Select","Select",""],["","61314054701","LATANOPROST","SOL 0.00005","2.5","Select","Select",""],["","00054001725","PREDNISONE","TAB 10MG","10","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","51672130803","CLOTRIM\/BETA","LOT DIPROP","30","Select","Select",""],["","45802014167","CICLOPIROX","SOL 0.08","6.6","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","14","Select","Select",""],["","65702028810","FASTCLIX","MIS LANCETS","102","Select","Select",""],["","00185067401","HYDROXYZ","CAP 25MG","28","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA BL","100","Select","Select",""],["","43547042309","LOSARTAN\/HCT","TAB 50-12.5","90","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":""}]}]}