{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"UB ANIGNANAHC","gend":1,"add":"       NL BULC YERRUS 422                         ","city":"STEPHENS CITY            ","state":"VA","zip":"22655-9998","dob":"1992-08-20","age":"","mstatus":"","insh":"10113333","cliId":"","pno":"6804552128","cno":"","email":"","ename":"","eno":"","pphy":"SUWAL, ANIL","ppno":5404844800,"pcpadd":"390 S MAIN ST STE 201,","pcpcity":"Rocky Mount","pcpstate":"VA","pcpzip":241511767,"pcpcounty":"","pcpid":"","pcpname":"CARILION MEDICAL ASSOCIATES ROCKY MOUNT","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"224 SURREY CLUB LN                                ","madd2":"                                                  ","madd3":"","mcity":"STEPHENS CITY            ","mstate":"VA","mzip":"22655-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N92.6","J02.9","Z00.00","J06.9","Z20.822","R05.3","L71.0","Z30.41","Z63.4","E55.9","R05","F33.0","J01.90","Z03.818","N93.9","R31.9","N76.0","N39.0","F84.5","F90.9","F43.12","L20.9","J30.9","H91.13","H55.00","H52.4","K06.8","Z68.20","H90.3","J31.0","R09.82","R09.89","J01.10","R05.1","J30.2","R05.9","J30.1","J30.89","J30.81","L20.89","Z01.419","Z30.09","Z23","F43.21","F41.8","R25.2","H10.13","U07.1","R11.0","Z88.2","H66.92","E78.5","M54.50","Z76.89","F29","Z74.3","R07.89","F41.9","R20.2","R45.0","R79.1","R07.9","R79.89","R06.02","M26.621","Z30.9"," ","Z79.3","E78.00","F43.10","F32.89","L30.9"],"date":["2021-01-06","2021-10-24","2022-09-07","2022-01-12","2022-01-12","2022-05-05","2021-02-08","2021-02-08","2021-02-08","2021-02-08","2021-08-10","2022-01-25","2021-04-14","2021-04-15","2022-09-11","2021-04-22","2021-04-29","2022-11-09","2022-11-11","2020-07-25","2022-08-25","2021-10-28","2020-07-25","2020-07-25","2020-07-25","2020-07-25","2020-07-25","2020-07-25","2021-08-10","2021-10-28","2021-08-10","2021-08-10","2021-10-24","2021-10-24","2022-01-25","2022-01-25","2022-05-05","2022-05-05","2022-05-05","2021-12-14","2020-12-10","2022-06-29","2022-11-09","2022-05-04","2022-09-07","2022-05-04","2022-05-05","2022-06-01","2022-06-01","2022-06-01","2022-06-22","2022-09-12","2022-09-12","2022-09-12","2022-09-16","2022-09-16","2022-09-16","2022-11-11","2022-09-16","2022-09-16","2022-09-16","2022-09-16","2022-09-16","2022-09-16","2022-09-30","2022-09-07","2022-11-11","2022-11-09","2022-11-11","2022-11-11","2022-11-11","2022-11-11"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"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":[["","00024591502","DUPIXENT","INJ 300\/2ML","4","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","180","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","70700011685","ALTAVERA","TAB ","84","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","69238153106","LARISSIA","TAB ","84","Select","Select",""],["","65862019405","FLUOXETINE","CAP 40MG","90","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00555902858","JUNEL","TAB 1.5\/30","84","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","1.00","Select","Select",""],["","55724021121","EUCRISA","OIN 0.02","60","Select","Select",""],["","23155019201","BUPROPION","TAB 100MG","60","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","51991081403","AZELASTINE","SPR 0.001","90","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.50","Select","Select",""],["","00603459315","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","70700011885","VIENVA","TAB 0.1-20","84","Select","Select",""],["","49884051101","MINOCYCLINE","TAB 50MG","60","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":""}]}]}