{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YKCIRKOOC L","gend":0,"add":"   DAOR HCNARB YKCOR 6211                         ","city":"LURAY                    ","state":"VA","zip":"22835-4763","dob":"1962-07-05","age":"","mstatus":"","insh":"00119297","cliId":"","pno":"4204520924","cno":5407423048,"email":"","ename":"","eno":"","pphy":"BRUBAKER, NANCY L","ppno":5404773185,"pcpadd":"120 MEDICAL DR,","pcpcity":"Mount Jackson","pcpstate":"VA","pcpzip":228429417,"pcpcounty":"","pcpid":"","pcpname":"RMH MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"1126 ROCKY BRANCH ROAD                            ","madd2":"                                                  ","madd3":"","mcity":"LURAY                    ","mstate":"VA","mzip":"22835-4763","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I47.1","R00.0","I10","E11.9","R00.2","R07.9","K21.9","Z12.5","E03.9","E78.2","M54.40","J40","R05","E11.65","J44.9","J20.9","Z20.822","R04.2","S60.222A","M79.642","X58.XXXA","M19.042","S69.92XA","Z23","R10.13","R07.89","I47.2","Z79.899","E05.90","F41.9","J98.11","E78.5","M79.604","M79.605","R53.81","I25.10","R53.83","Z00.00","I20.0","J98.6","R91.8","I21.4","Z95.5","D69.2","I25.110","I12.9","E11.22","N18.2","E66.01","Z68.37","Z28.310","Z79.82","Z79.84","Z79.890","Z82.49","Z88.8","Z88.3","R07.2","R06.02","R73.9"," ","K21.00","Z09","K06.8","J34.89"],"date":["2022-07-20","2022-06-20","2022-07-20","2022-11-03","2022-04-14","2022-06-22","2022-08-26","2021-02-08","2022-06-15","2022-11-03","2021-02-08","2021-09-17","2021-09-17","2022-11-02","2022-06-06","2021-08-25","2021-09-17","2021-09-17","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-27","2022-08-24","2022-06-22","2021-10-26","2021-10-26","2019-11-05","2019-12-19","2022-06-09","2022-07-20","2022-07-05","2022-07-05","2022-06-19","2022-07-20","2022-06-19","2022-03-23","2022-06-16","2022-06-19","2022-06-19","2022-06-20","2022-06-20","2022-06-20","2022-06-15","2022-06-15","2022-06-15","2022-06-15","2022-06-15","2022-06-15","2022-06-15","2022-06-15","2022-06-15","2022-06-15","2022-06-15","2022-06-15","2022-06-15","2022-06-14","2022-05-21","2022-11-02","2022-11-03","2022-08-24","2022-11-03","2022-08-26","2022-08-26"],"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":[["","00378235193","ESOMEPRA","CAP 40MG DR","90","Select","Select",""],["","00378181710","LEVOTHYROXIN","TAB 175MCG","90","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","180","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","90","Select","Select",""],["","57664016758","METOPROL","TAB 100MG","270","Select","Select",""],["","50111064701","FLUOXETINE","CAP 10MG","90","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","15","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","16729020001","BUSPIRONE","TAB 5MG","270","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","10","Select","Select",""],["","10370074601","GLIPIZIDE","TAB 10MG","90","Select","Select",""],["","378518693","PRASUGREL","TAB 10MG","90","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","00173072020","FLOVENT","AER 220MCG","12","Select","Select",""],["","31722070190","LOSARTAN","TAB 50MG","90","Select","Select",""],["","00093727198","PIOGLITAZONE","TAB 15MG","90","Select","Select",""],["","70377003012","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","93221001","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","70436000203","POT  CHLORIDE","TAB 10MEQ ER","45","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","20","Select","Select",""],["","169413212","OZEMPIC","INJ 2\/1.5ML","1.5","Select","Select",""],["","66758017001","KLOR-CON","TAB 10MEQ ER","90","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA BL","100","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":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}