{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ENNEIRDAEGIAP J ","gend":1,"add":"         DAOR SKRUB   391                         ","city":"AMHERST                  ","state":"VA","zip":"24521-3484","dob":"1990-08-05","age":"","mstatus":"","insh":"10114947","cliId":"","pno":"6643498171","cno":"","email":"","ename":"","eno":"","pphy":"CROOK, MEAGHAN TERESE","ppno":2073237484,"pcpadd":"115 AMBRIAR PLZ,","pcpcity":"Amherst","pcpstate":"VA","pcpzip":245214741,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"193   BURKS ROAD                                  ","madd2":"                                                  ","madd3":"","mcity":"AMHERST                  ","mstate":"VA","mzip":"24521-3484","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.63","F31.32","O13.3","O14.93","Z3A.33","R53.83","R53.1","O14.90","O10.93","R03.0","O90.89","R00.2","G43.009","Z87.440","Z77.22","Z79.899","Z88.8","Z91.040","Z91.013","Z87.891","Z91.410","Z56.0","Z83.49","Z3A.32","Z39.1","Z34.82","Z34.83","O80","Z3A.00","Z37.0","O16.5","R51.9","O26.899","O47.9","O23.40","O11.3","Z3A.34","I10","Z34.90","Z11.1","O14.03","O99.343","F32.9","F41.9","O23.43","O26.893","R10.13","Z80.3","Z81.8","Z82.49","O14.14","O62.3","E78.2","Z30.011","F31.81","O02.1","R42","Z87.59","O03.4","N39.0","F31.9","O03.9","R10.9","N89.8","O46.90","O26.891","R10.2","N93.8","O26.892","O36.8320","Z3A.14","N85.4","R11.0","F41.8","F43.10","R52","M54.9","M25.519","Z30.09","Z30.430","E07.9","R23.2","Z12.4"," ","Z11.51","Z01.419"],"date":["2022-08-11","2022-11-28","2021-03-12","2021-03-17","2021-03-17","2021-03-24","2022-08-25","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-09","2021-03-11","2021-03-11","2021-03-11","2021-03-18","2021-03-17","2021-03-18","2021-03-25","2022-08-25","2021-02-25","2021-02-25","2021-02-25","2021-03-16","2021-03-18","2022-09-23","2021-02-24","2021-09-01","2021-03-04","2021-03-04","2021-03-04","2022-09-23","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2021-03-16","2021-03-16","2022-06-20","2022-06-20","2022-06-20","2022-08-08","2022-08-25","2022-08-25","2022-08-04","2022-08-04","2022-08-25","2022-09-23","2022-08-03","2022-08-03","2022-08-03","2022-08-03","2022-08-03","2022-08-25","2022-08-03","2022-08-03","2022-08-03","2022-08-03","2022-08-25","2022-08-25","2022-09-23","2022-08-25","2022-08-25","2022-08-25","2022-09-23","2022-10-24","2022-10-24","2022-10-24","2022-10-24","2022-11-28","2022-10-24","2022-10-24"],"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":[["","23155000810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","50742061610","METOPROL","TAB 50MG ER","30","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","51672130406","TERCONAZOLE","CRE 0.004","90","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00555902658","JUNEL","TAB 43831","84","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","50742026001","NIFEDIPINE","TAB 30MG ER","30","Select","Select",""],["","49884012201","LABETALOL","TAB 100MG","90","Select","Select",""],["","59762500801","MISOPROSTOL","TAB 200MCG","4","Select","Select",""],["","62332002891","LOSARTAN","TAB 50MG","90","Select","Select",""],["","52544008201","FIORICET","CAP CODEINE","20","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","20","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","90","Select","Select",""],["","65862022701","LAMOTRIGINE","TAB 25MG","70","Select","Select",""],["","70954001910","PRAZOSIN","CAP 1MG","60","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","30","Select","Select",""],["","00555901658","SPRINTEC","TAB 28 DAY","84","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":""}]}]}