{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ON DERFLAMAHGNITT","gend":0,"add":"OTPMOC 3251EN TEERTS N","city":"ROANOKE","state":"VA","zip":24012,"dob":"1955-12-04","age":"","mstatus":"","insh":"10114956","cliId":"","pno":"1504558679","cno":"","email":"","ename":"","eno":"","pphy":"MAZEN MADHOUN MD LLC","ppno":5405197685,"pcpadd":"324 KING GEORGE AVE SW,","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24016,"pcpcounty":"","pcpid":"","pcpname":"NURSING HOME AVANTE AT ROANOKE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"Roanoke\/Alleghany","aligned":"Y","ano":"","add2":"APT #3","add3":"","madd1":"1523 COMPTON STREET NE","madd2":"APT #3","madd3":"","mcity":"ROANOKE","mstate":"VA","mzip":"24012-5743","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","Z79.4","I10","E10.65","G62.9","Z72.0","K21.9","L30.9"," ","Z12.5","Z00.00","Z12.11","Z12.12"],"date":["2021-05-16","2021-05-16","2022-07-13","2022-09-20","2022-07-13","2022-07-13","2022-07-13","2021-07-13","2022-09-20","2022-07-13","2022-07-13","2022-07-13","2022-07-13"],"priorHcc":["","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"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":[["","49281012265","FLUZONE","INJ 2022-23","0.7","Select","Select",""],["","5200010","PREVNAR","INJ ","0.5","Select","Select",""],["","58160081552","TWINRIX","INJ ","1","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2.00","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","100.00","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","90.00","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","15.00","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","15.00","Select","Select",""],["","31722070290","LOSARTAN","TAB 100MG","90.00","Select","Select",""],["","50228018005","GABAPENTIN","CAP 300MG","30.00","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":""}]}]}