{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ACINORREBSLEINAD M","gend":1,"add":"DAOR KROF RETSEL DLO 5494                 YDNURG  ","city":"GRUNDY                   ","state":"VA","zip":"24614-9998","dob":"1971-07-15","age":"","mstatus":"","insh":"10116777","cliId":"","pno":"1367200202","cno":"","email":"","ename":"","eno":"","pphy":"COPLEY, CHRISTOPHER","ppno":2769351760,"pcpadd":"1532 SLATE CREEK RD STE 106,  ","pcpcity":"Grundy","pcpstate":"VA","pcpzip":246146975,"pcpcounty":"","pcpid":"","pcpname":"COMMONWEALTH FAMILY CARE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"4945 OLD LESTER FORK ROAD  GRUNDY                 ","madd2":"                                                  ","madd3":"","mcity":"GRUNDY                   ","mstate":"VA","mzip":"24614-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z45.02","K30","E78.00","I50.9","C50.919","L40.59","L40.9","Z79.899","J30.1","Z95.810","R21","G47.33","Z79.89","I42.8","R53.83","I50.22","I10","E78.2","Z78.9","Z11.52","Z20.822","Z85.3","Z08","J20.9","R05","G47.10","G47.9","R06.83","I47.1","Z51.81","K21.9","F34.1","I11.0","E87.6","R11.2","I07.1","G47.30"],"date":["2022-01-12","2022-08-03","2022-01-21","2022-08-03","2022-01-24","2022-03-14","2022-03-14","2022-03-14","2022-08-03","2022-07-14","2022-03-14","2022-07-28","2021-11-04","2022-05-25","2022-02-15","2021-12-14","2022-05-25","2022-05-25","2022-07-14","2021-12-21","2022-01-02","2021-12-15","2021-12-15","2021-08-25","2021-08-25","2022-03-24","2022-03-22","2022-05-24","2022-01-13","2021-04-01","2021-10-11","2021-12-20","2022-01-02","2022-01-02","2022-01-02","2022-04-05","2022-05-24"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":[["","13668001990","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","00054429931","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","68462035701","POT  CHLORIDE","CAP 10MEQ ER","30","Select","Select",""],["","50742061710","METOPROL","TAB 100MG ER","180","Select","Select",""],["","70700015010","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","42571012290","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","00093720210","PRAVASTATIN","TAB 40MG","30","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","60","Select","Select",""],["","00074055402","HUMIRA","INJ 40\/0.4ML","2","Select","Select",""],["","00536110301","ALCOHOL","PAD 0.7","2","Select","Select",""],["","16729048601","METHOTREXATE","TAB 2.5MG","20","Select","Select",""],["","00832532411","POT  CL MICRO","TAB 10MEQ ER","30","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","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":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}