{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" P SEMAJNAMEERF","gend":0,"add":"       DAOR NWOTYRNEH 333                         ","city":"SALTVILLE                ","state":"VA","zip":"24370-3103","dob":"1957-07-10","age":"","mstatus":"","insh":"10111669","cliId":"","pno":"8267250015","cno":"","email":"","ename":"","eno":"","pphy":"SOMERVELL, PAMELA M","ppno":2764964433,"pcpadd":"308 W MAIN ST,","pcpcity":"Saltville","pcpstate":"VA","pcpzip":243703112,"pcpcounty":"","pcpid":"","pcpname":"SALTVILLE MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"333 HENRYTOWN ROAD                                ","madd2":"                                                  ","madd3":"","mcity":"SALTVILLE                ","mstate":"VA","mzip":"24370-3103","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","I48.19","K21.9","F15.10","F12.10","F17.210","Z71.51","Z79.891","M54.50","F11.21","F33.2","I10","R21","Z11.59","Z11.4"," "],"date":["2022-08-17","2022-08-24","2022-08-17","2022-08-17","2022-08-17","2022-08-17","2022-08-24","2022-08-24","2022-08-24","2022-08-24","2022-08-17","2022-08-24","2022-08-03","2022-08-24","2022-08-24","2022-08-24"],"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":[["","42806031250","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","21922002107","PERMETHRIN","CRE 0.05","60","Select","Select",""],["","55111046701","METOPROL","TAB 50MG ER","90","Select","Select",""],["","68382013710","LOSARTAN","TAB 100MG","90","Select","Select",""],["","43598021055","SSD","CRE 0.01","50","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","00781717612","NALOXONE","SPR 4MG","2","Select","Select",""],["","00378876793","BUPREN\/NALOX","MIS 8-2MG","14","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","90","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":[]}},{"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":""}]}]}