{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ID L ELRAERJ ETTEMM","gend":0,"add":"         DR ENIZOMAN 8665                         ","city":"CREWE                    ","state":"VA","zip":"23930-9998","dob":"1966-05-02","age":"","mstatus":"","insh":"00118715","cliId":"","pno":"6243459624","cno":"","email":"","ename":"","eno":"","pphy":"ALLEGA, GIULIANA ADELE","ppno":4343155340,"pcpadd":"935 S MAIN ST,","pcpcity":"Farmville","pcpstate":"VA","pcpzip":239012211,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"4103 Old Shore Road                               ","madd2":"                                                  ","madd3":"","mcity":"BLACKSTONE               ","mstate":"VA","mzip":"23824-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.5","E78.5","E11.9","K21.9","E11.40","M19.90","Z53.20","E11.29","N52.9","I10","E78.1","Z91.14","K22.2","K21.00","Z12.11","Z72.0","G45.9"," "],"date":["2022-03-08","2022-03-08","2022-06-02","2022-06-02","2022-03-08","2022-06-02","2022-06-02","2022-06-02","2022-06-02","2022-06-02","2022-06-02","2022-06-02","2022-03-18","2022-03-18","2022-03-18","2022-03-15","2022-03-15","2022-06-02"],"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":[["","68462039710","OMEPRAZOLE","CAP 40MG","30.00","Select","Select",""],["","16729002010","PIOGLITAZONE","TAB 15MG","30","Select","Select",""],["","60505014201","GLIPIZIDE","TAB 10MG","180.00","Select","Select",""],["","68180036309","FENOFIBRATE","TAB 160MG","30","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","90.00","Select","Select",""],["","72205001390","PREGABALIN","CAP 75MG","60.00","Select","Select",""],["","33332032203","AFLURIA","INJ 2022-23","0.5","Select","Select",""],["","00378247401","DICLOFEN","TAB 50MG","30","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":""}]}]}