{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" C SEMAJDRALLIW","gend":0,"add":" B43 TPA ECALP SIRRAH 831                         ","city":"DANVILLE                 ","state":"VA","zip":"24541-4315","dob":"1961-03-05","age":"","mstatus":"","insh":"10114179","cliId":"","pno":"4767280273","cno":"","email":"","ename":"","eno":"","pphy":"WINFIELD II, ALBERT C","ppno":4347914110,"pcpadd":"173 EXECUTIVE DR,","pcpcity":"Danville","pcpstate":"VA","pcpzip":245414101,"pcpcounty":"","pcpid":"","pcpname":"PROVIDENCE FAMILY AND SPORTS MEDICINE INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"138 HARRIS PLACE APT 34B                          ","madd2":"                                                  ","madd3":"","mcity":"DANVILLE                 ","mstate":"VA","mzip":"24541-4315","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.32","R06.09","I25.10","I25.5","T82.898S","E11.9","E78.5","F41.1","F32.2","I10","I50.9","J44.9","Z12.5","Z13.29","Z79.899","H40.013","H26.492","H52.02","H52.13","H52.223","H52.4"," ","R06.00","E78.2","I11.0","I50.22","Z95.1","I25.2","Z79.02","Z79.82","Z79.85","F41.8","K21.9"],"date":["2022-12-04","2022-08-16","2022-11-29","2022-11-29","2022-09-13","2022-11-28","2022-11-28","2022-11-10","2022-11-10","2022-11-21","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-11-28","2022-10-28","2022-10-28","2022-10-28","2022-10-28","2022-10-28","2022-10-28","2022-12-04","2022-11-21","2022-11-29","2022-11-28","2022-11-28","2022-11-28","2022-11-28","2022-11-28","2022-11-28","2022-11-28","2022-11-28","2022-11-28"],"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":[["","67877041530","VALSARTAN","TAB 40MG","30","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","68180032002","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","00193658621","MICROLET","MIS LANCETS","100","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","76385011050","CARVEDILOL","TAB 3.125MG","60","Select","Select",""],["","23155050201","HYDROXYZ","TAB 50MG","60","Select","Select",""],["","68180035103","SERTRALINE","TAB 25MG","30","Select","Select",""],["","33342006707","OLANZAPINE","TAB 2.5MG","30","Select","Select",""],["","13107003234","MIRTAZAPINE","TAB 45MG","30","Select","Select",""],["","61314063705","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","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":""}]}]}