{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" M SIOLSLOHCIN","gend":1,"add":"         DR YRREBYAM 9317                         ","city":"SINGERS GLEN             ","state":"VA","zip":"22850-9998","dob":"1943-01-18","age":"","mstatus":"","insh":"00115305","cliId":"","pno":"3404556325","cno":5408338788,"email":"","ename":"","eno":"","pphy":"WYRICK, KIMBERLY F","ppno":5404333344,"pcpadd":"1751 ERICKSON AVE,  ","pcpcity":"Harrisonburg","pcpstate":"VA","pcpzip":228018555,"pcpcounty":"","pcpid":"","pcpname":"ROCKINGHAM FAMILY PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"N","ano":"","add2":"                                                  ","add3":"","madd1":"7139 MAYBERRY RD                                  ","madd2":"                                                  ","madd3":"","mcity":"SINGERS GLEN             ","mstate":"VA","mzip":"22850-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H25.11","H25.811","Z88.8","Z98.42","Z96.1","H04.122","M85.89","Z13.6","Z00.00","N81.10","I86.8","N64.89","R92.2","E83.51","E28.39","Z12.31","L97.922","L03.116","I10","E11.9","H25.13","H25.011","H25.042","H25.12","H25.812","Z79.1","M17.12","M17.11","I83.028","Z13.1"],"date":["2020-01-09","2020-01-09","2020-01-09","2020-01-09","2020-01-09","2020-01-09","2022-06-13","2022-06-08","2022-06-08","2020-03-19","2022-06-08","2019-03-25","2019-03-25","2020-05-05","2020-05-05","2021-07-02","2021-06-29","2021-06-29","2021-07-10","2021-07-10","2019-10-22","2019-10-22","2019-10-22","2019-12-19","2019-12-19","2019-12-19","2022-06-16","2022-06-08","2022-06-08","2022-06-08"],"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":[["","60758077305","KETOROLAC","SOL 0.004","5","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","14","Select","Select",""],["","60505058204","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","61314063705","PREDNISOLONE","SUS 1% OP","10","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":""}]}]}