{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"H YRNEHTTELMA","gend":0,"add":"          TS NOTRAB S 001                         ","city":"MARTINSVILLE             ","state":"VA","zip":"24112-9998","dob":"1977-01-13","age":"","mstatus":"","insh":"00119447","cliId":"","pno":"5267205062","cno":2762528344,"email":"","ename":"","eno":"","pphy":"JAFF, TWANA","ppno":2766703300,"pcpadd":"1107A BROOKDALE ST,","pcpcity":"Martinsville","pcpstate":"VA","pcpzip":241124501,"pcpcounty":"","pcpid":"","pcpname":"CARILION CLINIC FP AND IM MARTINSVILLE RH","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"N","ano":"","add2":"                                                  ","add3":"","madd1":"100 S BARTON ST                                   ","madd2":"                                                  ","madd3":"","mcity":"MARTINSVILLE             ","mstate":"VA","mzip":"24112-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R69","Z47.81","E11.69","M86.271","E11.22","I12.9","N18.3","E11.51","Z45.2","Z51.81","Z79.2","R30.0","R35.0","G80.9","I10","Z79.899","Z00.00","M62.830","E08.65","E78.00","B36.0","J01.90","J02.9","R05","Z20.822","R36.9","Z23","E78.49","H53.8","L84","E11.65","Z12.11","J30.9","E86.0","E78.5","Z79.891","Z98.1","Z83.3"," ","N18.1"],"date":["2021-08-01","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-07-05","2019-07-05","2022-05-13","2022-05-13","2022-05-13","2022-05-12","2022-05-12","2022-09-08","2019-07-16","2022-09-08","2021-09-03","2021-09-03","2021-09-03","2022-05-13","2019-09-28","2022-09-08","2022-09-08","2021-02-01","2021-02-01","2022-09-08","2022-05-12","2022-09-08","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2022-09-08","2022-09-08"],"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":[["","64679096401","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","53885000810","ONETOUCH","MIS PLUS 33G","100","Select","Select",""],["","8290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","00378718505","METFORMIN","TAB 500MG","180","Select","Select",""],["","00093057610","LOVASTATIN","TAB 20MG","90","Select","Select",""],["","93321992","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","8627001601","DEXCOM","MIS TRANSMIT","1","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","30","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","88221905","LANTUS","INJ 100\/ML","18","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","270","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","169330312","NOVOLOG","INJ PENFILL","15","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","14","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":""}]}]}