{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A ANALANOSNIKT","gend":1,"add":"          ENAL TTELMAH 15                         ","city":"FARMVILLE                ","state":"VA","zip":"23901-9998","dob":"1974-04-10","age":"","mstatus":"","insh":"10110711","cliId":"","pno":"2243465783","cno":"","email":"","ename":"","eno":"","pphy":"BAVUSO, SALVATORE KARL","ppno":4343926143,"pcpadd":"202 AGEE ST,","pcpcity":"Farmville","pcpstate":"VA","pcpzip":239012617,"pcpcounty":"","pcpid":"","pcpname":"WOODLAND FAMILY PRACTICE LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"51 HAMLETT LANE                                   ","madd2":"                                                  ","madd3":"","mcity":"FARMVILLE                ","mstate":"VA","mzip":"23901-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.909","H25.813","I63.9","F41.9","Z71.89","Z71.3","Z23","Z20.828","R42","R20.0","E87.6","I65.21","I25.10","F41.8","F17.210","R07.9","F33.1","Z20.822","I10","R30.0","J45.20","Z01.419","Z12.31","N93.8","Z11.59","F41.1","R60.0","M79.89","R91.8","R06.89","R07.89","K21.9","Z13.220","R06.02","Z95.5","I67.2","R20.2","R51.9","I65.29","Z72.0","R03.0","N39.0","Z71.9","I16.1","I25.2","F32.9","Z79.82","Z79.899","Z79.02","J41.0","D25.9","Z01.30","N83.201","N83.202","R93.5"," "],"date":["2022-11-17","2021-01-21","2021-06-24","2021-07-19","2022-09-06","2020-11-20","2020-09-28","2022-02-15","2021-07-10","2021-06-25","2021-06-24","2021-06-23","2021-06-24","2021-06-24","2021-07-10","2021-07-10","2020-09-09","2022-02-15","2021-07-19","2021-11-09","2020-11-20","2021-12-10","2021-12-10","2022-09-14","2022-01-06","2020-11-19","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2021-07-10","2021-07-19","2021-07-19","2020-10-03","2021-06-23","2021-06-23","2021-06-23","2021-06-24","2021-06-24","2021-06-24","2021-07-10","2021-11-09","2021-11-09","2021-06-23","2021-06-23","2021-06-23","2021-06-23","2021-06-23","2021-06-23","2021-06-23","2022-09-14","2022-09-06","2022-09-14","2022-09-14","2022-09-14","2022-11-17"],"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":[["","69238111801","BUSPIRONE","TAB 15MG","90","Select","Select",""],["","68382080601","TRAZODONE","TAB 100MG","30","Select","Select",""],["","63304073530","ESOMEPRA","CAP 40MG DR","90","Select","Select",""],["","68180029606","DULOXETINE","CAP 60MG","32","Select","Select",""],["","43547040650","CLONAZEPAM","TAB 0.5MG","42","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8.5","Select","Select",""],["","00378001805","METOPROL","TAB 25MG","180","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","59762005601","MEDROXYPR","TAB 10MG","14","Select","Select",""],["","65862052790","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10.2","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","68382039801","POT  CHLORIDE","TAB 20MEQ ER","32","Select","Select",""],["","68382013905","TOPIRAMATE","TAB 50MG","90","Select","Select",""],["","49884030702","CLONAZEP","TAB 0.25MG","28","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00378395205","ATORVASTATIN","TAB 40MG","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":["",""]}},{"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":""}]}]}