{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"S EIKCIVNEDEERB ","gend":1,"add":"         DR NWOTREMOC 224                         ","city":"SHENANDOAH               ","state":"VA","zip":"22849-9998","dob":"1952-11-30","age":"","mstatus":"","insh":"10112443","cliId":"","pno":"4704574622","cno":5407422649,"email":"","ename":"","eno":"","pphy":"SHIFFLETT, LAURA WILKERSON","ppno":5407134100,"pcpadd":"13737 SPOTSWOOD TRL,","pcpcity":"Elkton","pcpstate":"VA","pcpzip":228273200,"pcpcounty":"","pcpid":"","pcpname":"RMH MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"422 COMERTOWN RD                                  ","madd2":"                                                  ","madd3":"","mcity":"SHENANDOAH               ","mstate":"VA","mzip":"22849-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z96.651","M25.561","R26.89","M17.12","I10","Z12.11","E78.2","F32.9","Z00.00","K21.9","R51.9","R41.0","Z85.42","Z87.891","Z88.8","Z91.040"," ","R41.3","M15.9","R06.02"],"date":["2020-08-18","2020-08-18","2020-08-18","2020-08-18","2022-06-01","2021-11-30","2022-06-01","2022-04-26","2022-04-26","2022-04-26","2022-04-30","2022-04-30","2022-04-30","2022-04-30","2022-04-30","2022-04-30","2022-12-01","2022-12-01","2022-12-01","2022-12-01"],"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":[["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","68180021509","LOSARTAN\/HCT","TAB 50-12.5","30","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","68001028103","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","68001040100","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","60505257908","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00378023110","ATENOLOL","TAB 50MG","30","Select","Select",""],["","16729020001","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","68001039708","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","93342510","LORAZEPAM","TAB 0.5MG","30","Select","Select",""],["","33332042010","AFLURIA","INJ 2020-21","0.5","Select","Select",""],["","70461012203","FLUAD","INJ 2022-23","0.5","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0.25","Select","Select",""],["","70461042010","FLUCLVX","INJ 2020-21","0.5","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":""}]}]}