{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" WEHTTAMYELSAL C","gend":0,"add":"              TS EGAP 134                         ","city":"ABINGDON                 ","state":"VA","zip":"24210-9998","dob":"1975-10-01","age":"","mstatus":"","insh":"10114538","cliId":"","pno":"2567299155","cno":2766087374,"email":"","ename":"","eno":"","pphy":"BARTON, REBECCA","ppno":2768890433,"pcpadd":"142 HIGHLAND DR,","pcpcity":"Lebanon","pcpstate":"VA","pcpzip":242664636,"pcpcounty":"","pcpid":"","pcpname":"SAMINA YOUSUF MD PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"PO BOX 981                                        ","madd2":"                                                  ","madd3":"","mcity":"ABINGDON                 ","mstate":"VA","mzip":"24212-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","E78.1","M54.50","M54.9","Z87.891","M54.59","C02.1","G89.4","Z00.00","H04.123","H52.13","E78.2","K21.9","G89.3","E66.09","Z68.32","N52.1","Z85.810","Z13.31","Z13.89","Z13.83","Z79.899","I15.9","Z68.33","Z79.891","M54.2","M79.2","E03.9","R73.01"," ","Z12.11"],"date":["2022-11-30","2021-10-15","2021-11-09","2021-11-09","2022-04-14","2021-11-09","2021-10-15","2022-02-23","2021-08-13","2021-12-16","2021-12-16","2022-09-22","2022-10-20","2022-11-17","2022-10-20","2022-04-14","2022-04-14","2022-08-24","2022-04-14","2022-04-14","2022-04-14","2022-07-25","2022-11-17","2022-10-20","2022-11-17","2022-02-23","2022-02-23","2022-10-20","2022-10-20","2022-11-30","2022-11-17"],"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":[["","16729000617","SIMVASTATIN","TAB 40MG","30","Select","Select",""],["","50228018010","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","42858010401","OXYCOD\/APAP","TAB 10-325MG","90","Select","Select",""],["","31722071310","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","43547035211","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","43386048024","ORPHENADRINE","TAB 100MG ER","60","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","45","Select","Select",""],["","31722012860","GEMFIBROZIL","TAB 600MG","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":""}]}]}