{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" EINALEMEILYW M","gend":1,"add":"       DR ELADNALLOH 4171                         ","city":"HENRICO                  ","state":"VA","zip":"23238-9998","dob":"1996-02-29","age":"","mstatus":"","insh":"10114649","cliId":"","pno":"1840846824","cno":"","email":"","ename":"","eno":"","pphy":"WESTIN, MARGARET C","ppno":8042881800,"pcpadd":"1800 GLENSIDE DR STE 110,","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232263769,"pcpcounty":"","pcpid":"","pcpname":"COMMONWEALTH PRIMARY CARE INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"1714 HOLLANDALE RD                                ","madd2":"                                                  ","madd3":"","mcity":"HENRICO                  ","mstate":"VA","mzip":"23238-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L72.3","Z68.25","I50.42","E66.01","Z95.0","Z87.74","Z86.79","G91.0","N63.22","Z68.41","I97.89","I49.3","I44.2","Q21.10","Q21.0","R94.31"," "],"date":["2022-09-21","2022-08-11","2022-07-20","2022-07-20","2022-10-06","2022-10-06","2022-10-06","2022-08-12","2022-10-13","2022-09-21","2022-10-06","2022-10-06","2022-10-06","2022-10-06","2022-10-06","2022-10-06","2022-10-13"],"priorHcc":["","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":[["","68180051201","LISINOPRIL","TAB 2.5MG","90","Select","Select",""],["","76385011250","CARVEDILOL","TAB 12.5MG","180","Select","Select",""],["","50742061610","METOPROL","TAB 50MG ER","30","Select","Select",""],["","53746051401","SPIRONOLACT","TAB 50MG","180","Select","Select",""],["","70461032203","FLUCLVX","INJ 2022-23","0.5","Select","Select",""],["","72578008601","DESONIDE","CRE 0.0005","15","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":""}]}]}