{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" A AUHSOJSNEHCUOH","gend":0,"add":"           DR SUCIMA 2796                         ","city":"RUCKERSVILLE             ","state":"VA","zip":"22968-9998","dob":"1984-10-25","age":"","mstatus":"","insh":"10115908","cliId":"","pno":"0843440838","cno":4342579127,"email":"","ename":"","eno":"","pphy":"WOLF, ANDREW MICHAEL","ppno":4349241212,"pcpadd":"100 COLONNADES HILL DR,","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":229012204,"pcpcounty":"","pcpid":"","pcpname":"THE COLONNADES HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"6972 AMICUS RD                                    ","madd2":"                                                  ","madd3":"","mcity":"RUCKERSVILLE             ","mstate":"VA","mzip":"22968-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E23.0","Z23","E66.9","H57.9","Z71.89","Z68.30","E03.8","E23.2","R61","D44.4","Z71.85","R07.9","S29.9XXA","M54.9","X50.0XXA","Z88.0","Z91.048","Z88.8","Z13.220","Z13.1","Z79.899","T14.8XXA","R07.89","R10.9","R06.02","R05.9","J18.9","R11.2","Z20.822","E87.1","Z28.310","Z91.09"," "],"date":["2022-05-25","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2022-05-25","2022-05-25","2022-05-25","2022-05-25","2022-05-25","2022-06-23","2022-06-23","2022-06-23","2022-06-23","2022-09-15","2022-06-23","2022-09-15","2022-05-25","2022-05-25","2022-05-25","2022-06-23","2022-06-23","2022-09-15","2022-09-15","2022-09-15","2022-09-15","2022-09-15","2022-09-15","2022-09-15","2022-09-15","2022-09-15","2022-09-15"],"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":[["","47335078891","DESMOPRESSIN","SPR 0.0001","15","Select","Select",""],["","00378181510","LEVOTHYROXIN","TAB 150MCG","90.00","Select","Select",""],["","64380097025","HYDROCORT","TAB 5MG","360","Select","Select",""],["","00143965901","TESTOST","INJ 200MG\/ML","3","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","4","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","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":""}]}]}