{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"S NERAKILLEC ","gend":1,"add":"     WS EUNEVA ANESAW 739                         ","city":"ROANOKE                  ","state":"VA","zip":"24015-9998","dob":"1957-08-31","age":"","mstatus":"","insh":"10113208","cliId":"","pno":"0404500370","cno":"","email":"","ename":"","eno":"","pphy":"HAIDER, SYED T","ppno":5403803722,"pcpadd":"3737 W MAIN ST,  STE 102","pcpcity":"Salem","pcpstate":"VA","pcpzip":241532073,"pcpcounty":"","pcpid":"","pcpname":"VALLEY INTERNAL MEDICINE ASSOCIATES PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"937 WASENA AVENUE SW                              ","madd2":"                                                  ","madd3":"","mcity":"ROANOKE                  ","mstate":"VA","mzip":"24015-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.9","I10","R73.9","E78.5","K59.00","R06.09","K22.8","Z09","Z12.11","K63.5","Z86.010","K57.30","H81.13","G47.09","K21.9","R06.02","R06.00","F31.9","J44.9","Z01.419","N95.2","Z12.31","K22.70","K31.89","Z20.828","M54.9","Z87.19","N39.0","Z12.4"],"date":["2022-08-03","2022-08-03","2022-07-08","2022-07-08","2022-04-11","2022-04-11","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2022-08-03","2022-08-03","2022-08-03","2021-07-19","2022-05-12","2022-07-08","2022-07-08","2022-07-11","2022-07-11","2022-05-17","2021-08-25","2021-08-25","2021-08-23","2022-07-08","2021-08-25","2021-06-14","2022-07-11"],"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":[]},{"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":[["","65162055710","TEMAZEPAM","CAP 30MG","30","Select","Select",""],["","68382014114","TOPIRAMATE","TAB 200MG","90","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","15","Select","Select",""],["","50742026001","NIFEDIPINE","TAB 30MG ER","90","Select","Select",""],["","55111015834","OMEPRAZOLE","CAP 20MG","90","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":[]}},{"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":""}]}]}