{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SEIVRACSREYA ","gend":1,"add":"OB OP153 X","city":"EXMORE","state":"VA","zip":23350,"dob":"1954-12-15","age":"","mstatus":"","insh":"10111023","cliId":"","pno":"5375784850","cno":"","email":"","ename":"","eno":"","pphy":"CHICK, JON BLAIR","ppno":7573505848,"pcpadd":"9434 HOSPITAL AVE","pcpcity":"NASSAWADOX","pcpstate":"VA","pcpzip":23413,"pcpcounty":"","pcpid":"","pcpname":"EASTERN SHORE RURAL HEALTH SYS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 351","madd2":"","madd3":"","mcity":"EXMORE","mstate":"VA","mzip":"23350-0351","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.31","Z78.0","E28.39","I10","E11.9","R73.03","J30.89","E66.09","Z68.38","Z87.891","M76.61","M25.561","E66.01","Z68.41","Z11.59","Z12.11","K63.5","Z86.010","K62.1","K57.30","K64.8","E78.5","Z79.51","Z79.82","Z79.84","Z79.899","E55.9","Z12.39","Z68.37","Z23","Z00.00","H40.1111","H40.1121","H25.11","H25.12","H52.11","H52.12","S83.412A","H40.1131"],"date":["2022-02-28","2021-01-13","2021-01-13","2022-03-01","2022-02-28","2021-10-01","2021-01-28","2021-05-27","2021-05-27","2021-10-01","2021-05-27","2021-04-14","2021-04-14","2021-04-14","2021-10-01","2020-07-31","2020-07-30","2020-07-30","2020-07-31","2020-07-30","2020-07-30","2021-10-01","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2020-09-02","2020-09-02","2021-10-01","2021-10-01","2020-10-06","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2022-02-28","2021-11-10"],"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":[["","16729000517","SIMVASTATIN","TAB 20MG","90.00","Select","Select",""],["","68180052001","LISINOP\/HCTZ","TAB 20-25MG","90.00","Select","Select",""],["","29300039810","AMLODIPINE","TAB 10MG","90.00","Select","Select",""],["","61314054701","LATANOPROST","SOL 0.00005","2.50","Select","Select",""],["","00378456105","POT  CHLORIDE","TAB 10MEQ ER","90.00","Select","Select",""],["","67877056110","METFORMIN","TAB 500MG","90.00","Select","Select",""],["","68462047101","POT  CL MICRO","TAB 10MEQ ER","90.00","Select","Select",""],["","55111068405","IBU","TAB 800MG","30.00","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354.00","Select","Select",""],["","50228043605","NAPROXEN","TAB 500MG","30.00","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":""}]}]}