{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Z ASILAUZARA","gend":1,"add":"LE N 801EUNEVA M","city":"HIGHLAND SPRINGS","state":"VA","zip":"23075-1435","dob":"1961-06-20","age":"","mstatus":"","insh":"10116234","cliId":"","pno":"5240895202","cno":"","email":"","ename":"","eno":"","pphy":"TUCKER, WILLIAM T","ppno":8042822580,"pcpadd":"2004 Bremo Rd, Ste 201","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232262442,"pcpcounty":"","pcpid":"","pcpname":"RICHMOND FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"108 N ELM AVENUE","madd2":"","madd3":"","mcity":"HIGHLAND SPRINGS","mstate":"VA","mzip":"23075-1435","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.02","U07.1","R09.02","Z20.822","J98.11","J98.4","I10","E11.49","E03.9","E78.00","S88.912S","E11.8","Z79.84","Z68.43","F06.4","Z51.5","R53.81","J12.82","E11.65","Z01.810","J18.1","E11.69","E66.9","I95.9","J96.01","E78.5","Z03.89","E11.9","E66.01","Z79.4","Z79.52","R69","G80.9","Z89.512","Z68.35","E11.40","Z99.3","Z79.899","Z97.3","Z89.9","Z68.42"],"date":["2022-01-21","2022-02-13","2022-02-07","2022-01-21","2022-01-22","2022-01-24","2021-10-26","2021-10-26","2022-02-05","2021-10-26","2021-01-26","2022-02-16","2022-02-16","2022-02-17","2022-02-04","2022-02-07","2022-02-07","2022-02-13","2022-02-17","2022-01-27","2022-01-31","2022-02-01","2022-02-01","2022-02-02","2022-02-05","2022-02-05","2022-02-03","2022-02-16","2022-02-11","2022-02-11","2022-02-11","2020-10-10","2020-09-26","2020-07-23","2020-07-23","2020-07-23","2020-09-26","2020-09-26","2020-09-26","2020-09-26","2020-09-26"],"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":[["","68180051901","LISINOP\/HCTZ","TAB 20-12.5","180","Select","Select",""],["","68645030059","METFORMIN","TAB 1000MG","180","Select","Select",""],["","69238183701","LEVOTHYROXIN","TAB 137MCG","90","Select","Select",""],["","68180047903","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","69097081307","GABAPENTIN","CAP 100MG","810","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","14","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}