{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AC E TREBORIII SSINAB","gend":0,"add":"      YWH YENNEKCCM 90521                         ","city":"MCKENNEY                 ","state":"VA","zip":"23872-9998","dob":"1973-02-19","age":"","mstatus":"","insh":"10113551","cliId":"","pno":"6640841651","cno":"","email":"","ename":"","eno":"","pphy":"HOLLAND, JOHN A","ppno":8044693731,"pcpadd":"13855 COURTHOUSE RD,","pcpcity":"Dinwiddie","pcpstate":"VA","pcpzip":238412254,"pcpcounty":"","pcpid":"","pcpname":"DINWIDDIE MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"12509 MCCKENNEY HWY                               ","madd2":"                                                  ","madd3":"","mcity":"MCKENNEY                 ","mstate":"VA","mzip":"23872-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H40.2233","H35.373","H40.1133","H25.13","Z01.818","H25.9","H54.3","H25.11","H40.2213","E66.9","H90.6","H91.93","H93.13","Z68.34","H90.5","R60.9","Z13.220","H90.0","Z12.11","Z23","H53.71","H53.72","H53.483"," "],"date":["2022-07-22","2022-07-22","2022-09-06","2020-06-22","2020-07-09","2020-07-09","2022-07-12","2020-07-23","2020-07-23","2022-07-26","2021-12-20","2020-08-12","2020-08-12","2022-07-26","2022-02-23","2022-07-26","2022-07-12","2022-07-12","2022-07-26","2022-07-26","2022-09-06","2022-09-06","2022-09-06","2022-09-06"],"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":[["","59762033302","LATANOPROST","SOL 0.00005","2.5","Select","Select",""],["","70069005101","DORZOL\/TIMOL","SOL 22.3-6.8","20","Select","Select",""],["","64980051501","OFLOXACIN","DRO 0.3% OP","10","Select","Select",""],["","00065924007","DUREZOL","EMU 0.0005","5","Select","Select",""],["","50742023301","ACETAZOLAMID","CAP 500MG ER","10","Select","Select",""],["","17478071510","BRIMONIDINE","SOL 0.2% OP","10","Select","Select",""],["","68682029905","LOTEPREDNOL","SUS 0.005","5.00","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","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":["",""]}},{"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":""}]}]}