{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M AVAHCIZDNA","gend":1,"add":"       DAOR REVODNAV 8142                         ","city":"HENRICO                  ","state":"VA","zip":"23229-9998","dob":"1958-01-02","age":"","mstatus":"","insh":"00119273","cliId":"","pno":"8340894700","cno":"","email":"","ename":"","eno":"","pphy":"MIRSHAHI, IRAJ","ppno":8046732814,"pcpadd":"5855 BREMO RD STE 102,STE 102","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232261926,"pcpcounty":"","pcpid":"","pcpname":"MONUMENT INTERNAL MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"2008 WADE COURT                                   ","madd2":"                                                  ","madd3":"","mcity":"HENRICO                  ","mstate":"VA","mzip":"23229-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","E78.00","G44.229","F33.41","G47.00","M25.562","F32.9","M17.0","F81.9","G89.29","Z68.28","Z12.31","M54.17","M47.816","M54.32","M51.36","M51.27","M51.16","M54.42","M51.26","E55.9","I10","N81.10","M25.561","M72.2","B35.1","A08.4","N81.11","B35.4","Z00.00","Z86.19","R10.9","H43.813","H25.13","Z23","F32.A","M15.9"," "],"date":["2019-09-06","2022-06-24","2019-02-08","2020-10-23","2020-10-23","2021-12-03","2020-05-14","2019-09-06","2019-02-08","2021-12-03","2022-06-21","2022-06-21","2019-03-24","2019-04-11","2019-05-15","2019-04-02","2019-05-15","2019-04-11","2021-06-11","2020-05-14","2022-06-24","2022-06-24","2021-06-11","2021-12-03","2022-06-21","2021-06-11","2018-08-13","2020-08-18","2018-08-24","2021-12-03","2019-09-06","2019-09-06","2021-10-01","2021-10-01","2021-12-03","2021-12-03","2022-06-21","2022-06-24"],"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":[["","68180037703","LOSARTAN","TAB 50MG","30","Select","Select",""],["","64380080806","IBUPROFEN","TAB 600MG","90","Select","Select",""],["","16729000617","SIMVASTATIN","TAB 40MG","30","Select","Select",""],["","68382080610","TRAZODONE","TAB 100MG","90","Select","Select",""],["","50228011505","FLUOXETINE","CAP 40MG","90","Select","Select",""],["","00378161001","DICYCLOMINE","CAP 10MG","60","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","51672139400","TRETINOIN","CRE 0.0005","20","Select","Select",""],["","57664037718","TRAMADOL","TAB 50MG","30","Select","Select",""],["","13668051501","ACYCLOVIR","OIN 0.05","15","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","45802014167","CICLOPIROX","SOL 0.08","6.6","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","90","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","21","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":""}]}]}