{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAILLIWYCATS ","gend":0,"add":"ROMDAED 95434 TPA TS E","city":"ABINGDON","state":"VA","zip":"24210-9998","dob":"1967-09-27","age":"","mstatus":"","insh":"10111567","cliId":"","pno":"1367254062","cno":"2763123041","email":"","ename":"","eno":"","pphy":"DHILLON, AMRITA KAUR","ppno":"2769646771          ","pcpadd":"1 Clinic Dr, ","pcpcity":"1 Clinic Dr,","pcpstate":"VA","pcpzip":"246411102","pcpcounty":"","pcpid":"","pcpname":"CLINCH VALLEY PHYSICIANS ASSOCIATES LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"459 DEADMORE ST APT 4","madd2":"","madd3":"","mcity":"ABINGDON","mstate":"VA","mzip":"24210-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B18.2","F17.210","R74.8","Z23","F41.8","F11.20","F41.1","F32.9","F17.200","F41.9","F60.9","F10.20","F12.20","F33.1","Z13.220","Z79.899","Z76.89","F90.9","J44.9","Z91.09","Z12.2","K70.30","F33.9","F19.90","R30.9","Z12.5","R76.8","Z87.891","R30.0","H43.399","K21.9","J30.2","F32.A"],"date":["2022-02-04","2022-01-03","2022-01-03","2022-01-03","2022-03-15","2022-03-16","2022-03-16","2022-03-16","2021-12-22","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-09-01","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-09-28","2021-08-19","2021-09-08","2021-08-19","2021-11-01","2021-08-19","2021-09-01","2021-09-01","2021-09-01","2021-09-08","2021-09-28","2021-09-28","2021-11-01","2021-11-01","2022-03-16"],"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":[["","12496120803","SUBOXONE","MIS 8-2MG","56.00","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","56.00","Select","Select",""],["","27241009990","DULOXETINE","CAP 60MG","30.00","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","30.00","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.50","Select","Select",""],["","69097084705","ESCITALOPRAM","TAB 5MG","30.00","Select","Select",""],["","00487020103","IPRATROPIUM\/","SOL ALBUTER","90.00","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16.00","Select","Select",""],["","72626270101","SOFOS\/VELPAT","TAB 400-100","28.00","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}