{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" B NIWDENOSPMIS","gend":0,"add":"  YAWHGIH PAG YCNAF 69061                         ","city":"CANA                     ","state":"VA","zip":"24317-9998","dob":"1953-03-01","age":"","mstatus":"","insh":"10113283","cliId":"","pno":"5767238044","cno":3363266243,"email":"","ename":"","eno":"","pphy":"SNYDER, DANAL SUE","ppno":3367864133,"pcpadd":"280 N POINTE BLVD,","pcpcity":"Mount Airy","pcpstate":"NC","pcpzip":270302267,"pcpcounty":"","pcpid":"","pcpname":"NORTHERN FAMILY MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"APT C                                             ","add3":"","madd1":"16096 FANCY GAP HIGHWAY                           ","madd2":"APT C                                             ","madd3":"","mcity":"CANA                     ","mstate":"VA","mzip":"24317-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","I10","G62.9","E78.5","F41.9","N40.0","R35.1","Z51.81","E11.69","E11.8","E11.65","Z68.28","Z79.899","E78.00","Z12.5","H25.811","I83.811","Z00.00","E11.40","Z68.30","E34.9","Z23","Z13.89","E11.59"," "],"date":["2022-09-13","2022-09-13","2022-09-13","2022-09-13","2022-09-13","2022-09-13","2022-02-16","2020-09-18","2020-09-23","2020-09-23","2022-02-16","2020-09-23","2020-12-23","2020-12-23","2022-05-11","2022-03-23","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2022-09-13","2022-05-17","2022-05-17","2022-09-13","2022-09-13"],"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":[["","00169413602","OZEMPIC","INJ 2\/1.5ML","9","Select","Select",""],["","67877019910","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","16714068303","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","43547035411","LISINOPRIL","TAB 20MG","90","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","00093005405","BUSPIRONE","TAB 10MG","180.00","Select","Select",""],["","00591292418","TESTOSTERONE","GEL 0.0162","75","Select","Select",""],["","64980028105","GLIPIZIDE","TAB 10MG","90","Select","Select",""],["","00469260130","MYRBETRIQ","TAB 25MG","90","Select","Select",""],["","31722070290","LOSARTAN","TAB 100MG","90","Select","Select",""],["","00597015390","JARDIANCE","TAB 25MG","90","Select","Select",""],["","00591024110","LORAZEPAM","TAB 1MG","180","Select","Select",""],["","00832141003","MOXIFLOXACIN","SOL HCL 0.5%","6.00","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","10.00","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":""}]}]}