{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"B A SINNERJ SKOOR","gend":0,"add":"RUHC 009RD LLIHC","city":"FREDERICKSBURG","state":"VA","zip":"22407-9998","dob":"1983-08-13","age":"","mstatus":"","insh":"10111771","cliId":"","pno":"4504508538","cno":"","email":"","ename":"","eno":"","pphy":"AMEEN, RICHARD J","ppno":"5407869771          ","pcpadd":"12006 Kilarney Dr, ","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":"224077207","pcpcounty":"","pcpid":"","pcpname":"CHANCELLOR INTERNAL MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"900 CHURCHILL DR","madd2":"","madd3":"","mcity":"FREDERICKSBURG","mstate":"VA","mzip":"22407-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S93.525D","H70.12","H61.21","H90.12","E03.9","F79","S93.525A","G47.33","L03.116","M79.674","Z00.00"],"date":["2021-07-24","2020-10-30","2020-10-30","2020-10-30","2021-03-30","2021-03-30","2021-07-16","2020-06-14","2021-07-22","2021-08-26","2020-12-07"],"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":[["","69238183307","LEVOTHYROXIN","TAB 88MCG","28.00","Select","Select",""],["","68462027130","ATOMOXETINE","CAP 100MG","28.00","Select","Select",""],["","23155050201","HYDROXYZ","TAB 50MG","28.00","Select","Select",""],["","00781705449","ERY\/BENZOYL","GEL 5-3%","23.30","Select","Select",""],["","00093227434","AMOX\/K","TAB 500-125","20.00","Select","Select",""],["","70461032003","FLUCLVX","INJ 2020-21","0.50","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30.00","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0.30","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":""}]}]}