{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" M TREBORRJ DRAWOH","gend":0,"add":"          DRAWOH EYAK O\/C                         ","city":"WAYNESBORO               ","state":"VA","zip":"22980-3836","dob":"1971-11-18","age":"","mstatus":"","insh":"00113926","cliId":"","pno":"3804577906","cno":"","email":"","ename":"","eno":"","pphy":"DUNBAR, KATHLEEN S","ppno":5409498241,"pcpadd":"428 S MAGNOLIA AVE,","pcpcity":"WAYNESBORO","pcpstate":"VA","pcpzip":229803608,"pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY MEDICINE ASSOCIATED PHYSICIAN","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"328 FLORENCE AVE                                  ","add3":"","madd1":"C\/O KAYE HOWARD                                   ","madd2":"328 FLORENCE AVE                                  ","madd3":"","mcity":"WAYNESBORO               ","mstate":"VA","mzip":"22980-3836","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.9","I10","E11.65","E78.2","Z23","E11.29","E66.01","D72.828","R80.9","Z68.42","N18.3","Z87.891","Z68.43","Z79.899","N18.31","D72.829","Z86.59","E11.9","D72.0","E87.6","R73.01","R60.9","R79.89","Z12.5","Z80.42","R00.0"," "],"date":["2022-10-17","2022-01-27","2022-01-24","2022-01-27","2022-01-27","2022-01-27","2022-01-27","2022-01-27","2022-01-27","2022-01-27","2020-08-06","2021-05-03","2020-05-13","2020-02-11","2021-05-03","2021-03-01","2021-05-03","2021-04-19","2021-05-03","2020-06-26","2019-10-01","2019-08-02","2020-08-06","2020-10-26","2020-10-26","2020-10-30","2022-10-17"],"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":[["","52817018210","CLONIDINE","TAB 0.3MG","60","Select","Select",""],["","00591037101","LOXAPINE","CAP 25MG","30","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","120","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","60","Select","Select",""],["","68180037703","LOSARTAN","TAB 50MG","90","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","53489014401","SPIRONO\/HCTZ","TAB 25\/25","30","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","58657060601","LABETALOL","TAB 200MG","60","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","90.00","Select","Select",""],["","00245531911","KLOR-CON","TAB 20MEQ ER","180","Select","Select",""],["","64980028001","GLIPIZIDE","TAB 5MG","90","Select","Select",""],["","00378606001","DILTIAZEM","CAP 60MG ER","60","Select","Select",""],["","68180052002","LISINOP\/HCTZ","TAB 20-25MG","60","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":""}]}]}