{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M LEKIMZNEAS ","gend":1,"add":" TPA YAWKRAP NAMEPOH 1001                       1Q","city":"WAYNESBORO               ","state":"VA","zip":"22980-9998","dob":"1979-09-30","age":"","mstatus":"","insh":"10110279","cliId":"","pno":"3243493127","cno":4343272139,"email":"","ename":"","eno":"","pphy":"BROOKINGS, MICHAEL E","ppno":5402457470,"pcpadd":"851 STATLER BLVD STE B,","pcpcity":"Staunton","pcpstate":"VA","pcpzip":244014894,"pcpcounty":"","pcpid":"","pcpname":"AUGUSTA HEALTH URGENT CARE STAUNTON","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"1001 HOPEMAN PARKWAY APT Q1                       ","madd2":"                                                  ","madd3":"","mcity":"WAYNESBORO               ","mstate":"VA","mzip":"22980-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.561","M25.551","M54.50","M25.461","M26.601","Z79.52","Z79.51","Z88.1","S83.90XA","N20.0","R52","R53.1","F41.9","M26.609","L30.9","M70.51"," "],"date":["2022-08-05","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2022-08-21","2022-08-21","2022-07-12","2022-07-12","2022-06-23","2022-06-23","2022-06-23","2022-08-11","2022-08-21"],"priorHcc":["","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":[["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","25.5","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","16729017117","AMITRIPTYLIN","TAB 10MG","100","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","14","Select","Select",""],["","00603533831","PREDNISONE","PAK 10MG","48","Select","Select",""],["","49884033601","FLUOXETINE","TAB 20MG","90","Select","Select",""],["","51672128902","NYSTATIN","CRE 100000","30","Select","Select",""],["","57237001760","DULOXETINE","CAP 20MG","180","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":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}