{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WERDNANOSYT ","gend":0,"add":"          TS SASSANAM 635                         ","city":"FRONT ROYAL              ","state":"VA","zip":"22630-9998","dob":"1988-05-24","age":"","mstatus":"","insh":"10111157","cliId":"","pno":"7904541035","cno":5402526711,"email":"","ename":"","eno":"","pphy":"SUWAL, ANIL","ppno":5404844800,"pcpadd":"390 S MAIN ST STE 201,","pcpcity":"Rocky Mount","pcpstate":"VA","pcpzip":241511767,"pcpcounty":"","pcpid":"","pcpname":"CARILION MEDICAL ASSOCIATES ROCKY MOUNT","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"536 MANASSAS ST                                   ","madd2":"                                                  ","madd3":"","mcity":"FRONT ROYAL              ","mstate":"VA","mzip":"22630-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.822","J02.9","R52","R19.7","Z87.09","L02.415","L72.0","L08.9","K76.0","R10.31","N50.811","R10.32","L02.214","J45.21","R05","R10.9","R05.9","R06.02","H92.09","J06.9","H66.93","Z87.19","R07.9","Z72.0","J20.9","E11.9","I10","R20.0","R07.0","U07.1"," "],"date":["2022-07-27","2022-07-20","2022-01-04","2022-01-04","2022-01-04","2021-02-13","2021-03-15","2021-03-15","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-09-13","2021-09-13","2021-09-13","2021-11-09","2022-06-17","2022-05-09","2022-02-28","2022-06-17","2022-02-28","2022-03-26","2022-05-09","2022-05-09","2022-05-05","2022-05-05","2022-05-05","2022-05-09","2022-07-20","2022-07-27","2022-07-27"],"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":[["","55111015330","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","28","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20.00","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","67877021660","CEFUROXIME","TAB 500MG","14","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8.5","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":""}]}]}