{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ENIRROCMALLEK ","gend":1,"add":"EMEC 67111DAOR YRAT","city":"EXMORE","state":"VA","zip":"23350-9998","dob":"1928-04-07","age":"","mstatus":"","insh":"10111980","cliId":"","pno":"4475740472","cno":7574427914,"email":"","ename":"","eno":"","pphy":"CHICK, JON BLAIR","ppno":7573363682,"pcpadd":"4049 Main St, ","pcpcity":"Chincoteague Island","pcpstate":"VA","pcpzip":233362406,"pcpcounty":"","pcpid":"","pcpname":"EASTERN SHORE RURAL HEALTH SYSTEM","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"11176 CEMETARY ROAD","madd2":"","madd3":"","mcity":"EXMORE","mstate":"VA","mzip":"23350-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I11.0","I10","F03.90","A41.51","R50.9","E43","C64.2","Z66","Z51.5","E87.2","N39.0","Z68.1","G30.9","F02.80","I48.0","R65.20","E03.9","N28.89","R15.9","K57.30","K82.8","R00.0","R19.7","R74.0","A41.50","D72.829","I08.8","R78.81","B96.20","Z74.01","I49.9","I44.0","R94.31","R68.89","D50.9","E87.6"],"date":["2022-02-13","2020-08-29","2020-08-29","2020-06-15","2020-06-16","2020-06-18","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-07-02","2020-06-15","2020-06-15","2020-06-17","2020-06-16","2020-07-02","2020-06-17","2020-06-15","2020-06-15","2020-06-15","2020-06-18","2020-06-15","2020-06-15","2020-06-16","2020-06-16","2020-06-17","2020-06-17","2020-06-17","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-07-02","2020-07-02"],"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":[["","69238184001","LEVOTHYROXIN","TAB 200MCG","30","Select","Select",""],["","51672404003","ENALAPRIL","TAB 20MG","90","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","90","Select","Select",""],["","00378001805","METOPROL","TAB 25MG","60","Select","Select",""],["","55111012601","CIPROFLOXACN","TAB 250MG","6","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":""}]}]}