{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ADNERBREKAB L","gend":1,"add":" DNALKOORB E 1221503 TPA DVLB KRAP","city":"RICHMOND                 ","state":"VA","zip":"23222-9998","dob":"1954-09-29","age":"","mstatus":"","insh":"10116429","cliId":"","pno":"2340848664","cno":8049726626,"email":"","ename":"","eno":"","pphy":"DICKERSON, TASHA B","ppno":8042257177,"pcpadd":"1510 N 28TH ST STE 300,STE 300","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232235311,"pcpcounty":"","pcpid":"","pcpname":"DOMINION MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"Apt 423","add3":"","madd1":"1221 E BROOKLAND PARK BLVD APT 305","madd2":"Apt 305","madd3":"","mcity":"RICHMOND                 ","mstate":"VA","mzip":"23222-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.32","R79.89","R79.9","R68.89","E55.9","E53.8","I10","Z68.28","R22.41","R51.9","R89.9","Z92.29","Z68.27","K21.9","F32.A"],"date":["2022-07-08","2022-10-18","2022-10-18","2022-10-18","2022-10-18","2022-10-18","2022-10-18","2022-07-20","2022-07-20","2022-07-20","2022-10-18","2022-10-18","2022-10-18","2022-10-18","2022-10-18"],"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":[["","16729021616","SERTRALINE","TAB 50MG","30","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","60","Select","Select",""],["","24979003703","METOPROL","TAB 25MG ER","30","Select","Select",""],["","69315015510","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","67877019910","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","66993058497","FLUTIC\/SALME","AER 100\/50","60","Select","Select",""],["","00378456105","POT  CHLORIDE","TAB 10MEQ ER","60","Select","Select",""],["","16714069803","VALACYCLOVIR","TAB 500MG","30","Select","Select",""],["","70710122700","AMITRIPTYLIN","TAB 50MG","30","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","60","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":""}]}]}