{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"J ADNARIMDRAOBED ","gend":1,"add":"    E EUNEVA DAORLIAR 533                         ","city":"BIG STONE GAP            ","state":"VA","zip":"24219-9998","dob":"1954-07-24","age":"","mstatus":"","insh":"10112832","cliId":"","pno":"9367293663","cno":"","email":"","ename":"","eno":"","pphy":"BASHAM, CHRISTOPHER M","ppno":2765236715,"pcpadd":"323 CLOVERLEAF SQ,  # 1","pcpcity":"Big Stone Gap","pcpstate":"VA","pcpzip":242192760,"pcpcounty":"","pcpid":"","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"335 RAILROAD AVENUE E                             ","madd2":"                                                  ","madd3":"","mcity":"BIG STONE GAP            ","mstate":"VA","mzip":"24219-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D12.4","Z86.010","R04.0","R39.81","N39.46","H40.1231","R94.111","R50.9","R05","R11.2","R10.9","Z20.822","Z78.9","F43.10","E78.00","D69.6","E66.01","D57.20","R79.89","K63.5","R10.13","K56.609","D57.1","K21.9","D64.9","R00.2","R71.0","M81.8","K56.600","R11.10","E78.5","R30.0","K56.699","R10.84","J32.9","J30.9","K62.89","Z12.31","J30.2","I42.9","H40.9","R42","F41.1","R35.1","M19.041","M19.042","M81.0","Z09","R53.83","M25.511","Z87.891","Z74.3","Z87.81","Z98.49","Z90.49","Z86.69","Z97.2","L30.9","E66.9","M26.609","Z87.19","Z68.34","N39.0","D58.2","Z68.35"],"date":["2022-04-11","2022-04-11","2021-01-14","2022-07-10","2022-07-10","2022-06-20","2022-06-20","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-01-19","2021-12-29","2021-12-29","2021-12-29","2021-12-29","2021-12-29","2021-12-29","2022-04-27","2021-12-29","2021-01-18","2021-01-20","2021-01-20","2021-01-20","2022-05-15","2022-05-15","2021-12-27","2021-12-27","2021-01-27","2021-01-18","2021-01-19","2021-06-29","2021-01-19","2021-01-19","2021-06-07","2020-04-16","2022-03-03","2021-03-17","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2021-01-19","2021-01-27","2022-05-15","2022-05-15","2022-05-15","2021-01-18","2020-06-29","2020-06-29","2021-01-19","2020-06-29","2020-06-29","2020-06-29","2021-01-19","2020-06-29","2020-06-29","2020-06-29","2021-01-19","2021-01-19","2021-01-19"],"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":[["","60505059301","TRAVOPROST","DRO 0.00004","5","Select","Select",""],["","00143928501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","13107008305","LORAZEPAM","TAB 0.5MG","60","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","10702000310","PROMETHAZINE","TAB 25MG","21","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":""}]}]}