{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" L IMATTHGIRW","gend":1,"add":"      DR LLIH YROKCIH 921                         ","city":"FISHERSVILLE             ","state":"VA","zip":"22939-9998","dob":"1971-11-16","age":"","mstatus":"","insh":"10112449","cliId":"","pno":"1404578186","cno":5409425109,"email":"","ename":"","eno":"","pphy":"CHEEK, KIMBERLY M","ppno":5402457930,"pcpadd":"201 LEW DEWITT BLVD,","pcpcity":"Waynesboro","pcpstate":"VA","pcpzip":229801663,"pcpcounty":"","pcpid":"","pcpname":"AUGUSTA HEALTH INTERNAL MEDICINE WAYNESBORO","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"129 HICKORY HILL RD                               ","madd2":"                                                  ","madd3":"","mcity":"FISHERSVILLE             ","mstate":"VA","mzip":"22939-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N18.32","N17.9","I10","E87.6","D53.9"," ","Z12.31","Z20.822","R05.9","J02.9","R53.83","D50.9","E53.8","Z00.00","E11.9","E78.5","E03.9","N18.30","D64.9","K21.9","J30.2","B00.1","E66.9","R13.10","I12.9","K44.9","K64.8","N18.9","E11.22","Z79.84","F79","Z79.02"],"date":["2022-04-25","2022-04-18","2022-06-17","2022-04-25","2022-04-18","2022-11-11","2022-08-09","2022-06-07","2022-06-07","2022-06-07","2022-06-07","2022-11-11","2022-09-20","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-11-11","2022-04-18","2022-04-18","2022-04-18","2022-04-18","2022-04-18","2022-04-18","2022-04-18","2022-04-18"],"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":{"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":[["","60505258008","ATORVASTATIN","TAB 40MG","28","Select","Select",""],["","61442012110","FAMOTIDINE","TAB 20MG","56","Select","Select",""],["","69097012815","AMLODIPINE","TAB 10MG","28","Select","Select",""],["","68180051901","LISINOP\/HCTZ","TAB 20-12.5","56","Select","Select",""],["","23155010410","METFORMIN","TAB 1000MG","56","Select","Select",""],["","378180710","LEVOTHYROXIN","TAB 88MCG","28","Select","Select",""],["","62037099910","POT  CL MICRO","TAB 20MEQ ER","56","Select","Select",""],["","16729002215","PIOGLITAZONE","TAB 45MG","28","Select","Select",""],["","57237004290","VALACYCLOVIR","TAB 500MG","28","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","70461032203","FLUCLVX","INJ 2022-23","0.5","Select","Select",""],["","66993037179","MEDROXYPR","INJ 150MG\/ML","1","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":[]}},{"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":[]}]},{"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":""}]}]}