{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"J YELSEWDROFDAR ","gend":0,"add":"       DR MURREF DLO 0413                         ","city":"FERRUM                   ","state":"VA","zip":"24088-9998","dob":"1964-05-13","age":"","mstatus":"","insh":"10112993","cliId":"","pno":"8404553673","cno":"","email":"","ename":"","eno":"","pphy":"MAXEY, JAMES","ppno":5404835168,"pcpadd":"195 MAPLE AVE,","pcpcity":"Rocky Mount","pcpstate":"VA","pcpzip":241511506,"pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY MEDICINE ROCKY MOUNT","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"3140 OLD FERRUM RD                                ","madd2":"                                                  ","madd3":"","mcity":"FERRUM                   ","mstate":"VA","mzip":"24088-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.00","I10","G40.909","E11.9","R56.9","E78.5","F70","Z68.39","E66.9","R32","R09.02","R25.1","R53.1","R47.9","W19.XXXA","R41.82","Z51.81","S01.552A","Z20.822","R94.31","E66.09","R63.4","Z23","F79","L72.3"," "],"date":["2022-10-21","2022-10-21","2022-10-21","2022-10-21","2021-05-15","2021-05-15","2022-10-21","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-14","2021-05-13","2021-05-13","2021-05-13","2021-05-14","2022-10-21","2022-10-21","2022-11-29","2022-10-21","2022-11-29"],"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":[["","68382075810","METFORMIN","TAB 500MG","180","Select","Select",""],["","68180011507","LEVETIRACETA","TAB 1000MG","60","Select","Select",""],["","13517011110","PHENOBARB","TAB 32.4MG","120","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","90","Select","Select",""],["","00093324356","BISOPRL\/HCTZ","TAB 10\/6.25","90","Select","Select",""],["","00093720298","PRAVASTATIN","TAB 40MG","90","Select","Select",""],["","68180045901","AMLOD\/BENAZP","CAP 5-20MG","90","Select","Select",""],["","00168005646","BETAMETH","OIN 0.0005","45","Select","Select",""],["","00071036924","DILANTIN","CAP 100MG","90","Select","Select",""],["","65862069201","PHENYTOIN","CAP 100MG","270","Select","Select",""],["","51672421503","METRONIDAZOL","GEL 0.01","60","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","15","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","49281042050","FLUZONE","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":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}