{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CM YNOTLEINAD","gend":0,"add":"              HCIWLUD 221                         ","city":"AMHERST                  ","state":"VA","zip":"24521-9998","dob":"1965-03-03","age":"","mstatus":"","insh":"10115319","cliId":"","pno":"0943489267","cno":4343008721,"email":"","ename":"","eno":"","pphy":"DAVIS, TABATHA BRITTANY","ppno":4342005200,"pcpadd":"2323 MEMORIAL AVE STE 10,STE 10","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245012652,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"APT#36                                            ","add3":"","madd1":"122 DULWICH                                       ","madd2":"APT#36                                            ","madd3":"","mcity":"AMHERST                  ","mstate":"VA","mzip":"24521-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z48.298","Z94.0","Z79.899","Z78.9","Z23","N52.9","E11.8","E78.5","I25.10","E11.3553","H25.811","H35.371","H35.82","H33.41","Z96.1","H47.233","H26.9","I10","R35.1","T86.12","E11.22","E87.5","E11.65","Z79.4","H25.89","H47.391","B25.9","E10.22","I15.1","I73.9","Z89.512","Z89.511","Z71.85","E87.2","N39.0","I25.119","N18.5"," ","E11.9","I11.9"],"date":["2022-08-24","2022-11-18","2022-08-24","2022-03-15","2022-10-24","2022-03-16","2022-10-25","2022-10-24","2022-03-16","2022-09-29","2022-06-23","2022-06-23","2022-09-29","2022-09-29","2022-06-23","2022-06-23","2022-03-21","2022-11-18","2022-10-24","2022-09-19","2022-10-24","2022-10-25","2022-06-23","2022-06-23","2022-06-23","2022-06-23","2022-06-23","2022-08-24","2022-08-24","2022-11-18","2022-05-18","2022-05-18","2022-08-24","2022-08-24","2022-08-24","2022-08-24","2022-08-24","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":{"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":[["","91237000173","EASY","MIS 31GX1\/4\"","100.00","Select","Select",""],["","16729009401","MYCOPHENOLAT","CAP 250MG","112.00","Select","Select",""],["","59746017210","PREDNISONE","TAB 5MG","28.00","Select","Select",""],["","75834025701","ATORVASTATIN","TAB 40MG","28.00","Select","Select",""],["","00310110530","LOKELMA","PAK 5GM","30.00","Select","Select",""],["","65862086099","FAMOTIDINE","TAB 40MG","22.00","Select","Select",""],["","29300039810","AMLODIPINE","TAB 10MG","28.00","Select","Select",""],["","57237001405","TAMSULOSIN","CAP 0.4MG","28.00","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","15.00","Select","Select",""],["","08222710048","PEN  NEEDLES","MIS 31GX6MM","100","Select","Select",""],["","00169430330","RYBELSUS","TAB 3MG","30.00","Select","Select",""],["","57599080000","FREESTY","KIT 2 SENSOR","2","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","15","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15.00","Select","Select",""],["","76385011150","CARVEDILOL","TAB 6.25MG","56","Select","Select",""],["","00193731150","CONTOUR","TES NEXT","100","Select","Select",""],["","68992304003","ENVARSUS","TAB 4MG","60.00","Select","Select",""],["","08484073200","PRODIGY","TES CODING","100","Select","Select",""],["","64380072304","CALCITRIOL","CAP 0.25MCG","12.00","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":""}]}]}