{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"R ASSEDONOSNIBO","gend":1,"add":"             TS ECURB 953                         ","city":"FRANKLIN                 ","state":"VA","zip":"23851-9998","dob":"1956-12-25","age":"","mstatus":"","insh":"10116288","cliId":"","pno":"1575762077","cno":"","email":"","ename":"","eno":"","pphy":"BROWN-TRUDEL, LINDA","ppno":7579252160,"pcpadd":"1033 28TH ST FL 2,","pcpcity":"Newport News","pcpstate":"VA","pcpzip":236074233,"pcpcounty":"","pcpid":"","pcpname":"EAST END PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"N","ano":"","add2":"                                                  ","add3":"","madd1":"359 BRUCE ST                                      ","madd2":"                                                  ","madd3":"","mcity":"FRANKLIN                 ","mstate":"VA","mzip":"23851-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M75.51","M17.12","E11.65","S43.431A","M75.111","M19.011","E10.3311","H25.13"," "],"date":["2022-02-15","2022-02-15","2022-03-03","2022-03-04","2022-03-04","2022-03-04","2022-03-31","2022-03-31","2022-03-31"],"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":[["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100.00","Select","Select",""],["","08317700050","RELION","TES ","300","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","30.00","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","90","Select","Select",""],["","67877041301","METFORMIN","TAB 500MG ER","180","Select","Select",""],["","65862085630","AMLOD\/OLMESA","TAB 10-20MG","30.00","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","54.00","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15.00","Select","Select",""],["","59267102504","PFIZER","INJ ADLT RTU","0.3","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":""}]}]}