{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" EDYLCREHSIF","gend":0,"add":"          DR KCORTALF 542                         ","city":"WAYNESBORO               ","state":"VA","zip":"22980-9998","dob":"1947-04-02","age":"","mstatus":"","insh":"00115159","cliId":"","pno":"4204521931","cno":"","email":"","ename":"","eno":"","pphy":"BERRYMAN, LESLIE A","ppno":2762582600,"pcpadd":"16000 JOHNSTON MEMORIAL DR STE 213,","pcpcity":"Abingdon","pcpstate":"VA","pcpzip":242110001,"pcpcounty":"","pcpid":"","pcpname":"BLUE RIDGE MEDICAL MANAGEMENT CORPORATION","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"245 FLATROCK RD                                   ","madd2":"                                                  ","madd3":"","mcity":"WAYNESBORO               ","mstate":"VA","mzip":"22980-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.2","D50.0","Z51.5","Z86.73","J45.909","I48.0","I48.91","E78.5","K21.9","F32.9"," ","I25.10"],"date":["2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2022-11-10","2021-02-24","2021-04-07","2021-04-07","2021-04-07","2022-11-10","2022-11-10"],"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":[["","68382002210","ATENOLOL","TAB 25MG","90","Select","Select",""],["","61314014305","BRIMONIDINE","SOL 0.2% OP","5","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","90","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","180","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","50383023310","DORZOL\/TIMOL","SOL 22.3-6.8","10","Select","Select",""],["","29300013010","HYDROCHLOROT","CAP 12.5MG","90","Select","Select",""],["","00378180910","LEVOTHYROXIN","TAB 100MCG","10","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","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":""}]}]}