{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A DERFLASUTSUJ ","gend":0,"add":"              1701 xoB OP                         ","city":"Vansant                  ","state":"VA","zip":"24656-1071","dob":"1983-02-12","age":"","mstatus":"","insh":"10112845","cliId":"","pno":"0267237392","cno":2762820004,"email":"","ename":"","eno":"","pphy":"DHILLON, AMRITA KAUR","ppno":2769646771,"pcpadd":"1 CLINIC DR,","pcpcity":"RICHLANDS","pcpstate":"VA","pcpzip":246411102,"pcpcounty":"","pcpid":"","pcpname":"CLINCH VALLEY PHYSICIANS ASSOCIATES LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"PO BOX 1071                                       ","madd2":"                                                  ","madd3":"","mcity":"VANSANT                  ","mstate":"VA","mzip":"24656-1071","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","Z79.891","Z51.81","Z79.899","F33.1","F41.1","F51.05","J35.1","J35.8","J31.2","R06.83","J34.1","S00.561A","W57.XXXA","T63.461A","F17.210","I45.81","I10","F41.9","F31.9","R73.03","E78.2","R20.0","M25.511","G89.29","M19.019","U07.1","M75.81","M79.604","M25.569","R74.8","M75.41","R53.83","G62.9"," ","Z01.810","M75.51","M19.011","E78.5","Z72.0"],"date":["2022-11-30","2021-10-20","2022-08-22","2022-11-30","2021-09-10","2021-09-10","2021-09-10","2021-06-24","2021-06-23","2021-06-23","2021-06-15","2021-06-24","2021-07-22","2021-07-22","2021-07-22","2022-11-30","2022-10-20","2022-11-30","2022-11-30","2022-11-30","2022-08-22","2022-08-22","2022-05-20","2022-10-27","2022-10-27","2022-08-22","2022-02-14","2022-06-03","2022-06-03","2022-06-03","2022-05-20","2022-11-30","2022-10-27","2022-11-22","2022-11-30","2022-11-30","2022-11-30","2022-11-30","2022-11-30","2022-10-27"],"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":[["","43547035311","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","62332001231","VENLAFAXINE","TAB 100MG","30","Select","Select",""],["","10702005601","OXYCODONE","TAB 10MG","28","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","112","Select","Select",""],["","00054018913","BUPREN\/NALOX","SUB 8-2MG","56","Select","Select",""],["","50383007916","APAP\/CODEINE","SOL 120-12\/5","473","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":""}]}]}