{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YELNATSSAMOHT N","gend":0,"add":"           EETAGRADEC 908                         ","city":"MONROE                   ","state":"VA","zip":"24574-9998","dob":"1959-11-28","age":"","mstatus":"","insh":"10111579","cliId":"","pno":"0243437079","cno":"","email":"","ename":"","eno":"","pphy":"THOMAS E DOBYNS MD","ppno":4345284312,"pcpadd":"4579 S AMHERST HWY,","pcpcity":"Madison Heights","pcpstate":"VA","pcpzip":245725343,"pcpcounty":"","pcpid":"","pcpname":"THOMAS E DOBYNS FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"P.O. BOX 235                                      ","madd2":"                                                  ","madd3":"","mcity":"MONROE                   ","mstate":"VA","mzip":"24574-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","I51.9","Z68.31","I10","R42","R50.9","R11.2","R11.0","R11.11","K21.00","E78.01","R39.12","B35.1","L60.3","E11.9","M50.80"," "],"date":["2022-12-12","2022-12-12","2022-10-19","2022-12-12","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-12-12","2022-06-15","2022-07-05","2022-07-05","2022-07-05","2022-10-19","2022-12-12"],"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":[["","59762040101","SUCRALFATE","TAB 1GM","40","Select","Select",""],["","45802014167","CICLOPIROX","SOL 0.08","6.6","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","90","Select","Select",""],["","57237011490","ALFUZOSIN","TAB 10MG ER","90","Select","Select",""],["","67877032101","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","68001039708","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","50111056103","TRAZODONE","TAB 100MG","30","Select","Select",""],["","60505100301","KETOROLAC","SOL 0.005","5","Select","Select",""],["","68180052001","LISINOP\/HCTZ","TAB 20-25MG","90","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","45","Select","Select",""],["","00713067815","NYSTATIN","CRE 100000","30","Select","Select",""],["","33342032980","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","50742062001","NIFEDIPINE","TAB 30MG ER","30","Select","Select",""],["","75834050005","METFORMIN","TAB 500MG ER","360","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","68001036500","METRONIDAZOL","TAB 500MG","28","Select","Select",""],["","00781196260","CLARITHROMYC","TAB 500MG","28","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"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":""}]}]}