{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"D YMMIJSUTSUJ ","gend":0,"add":"EUG DLO 2633DR KROF SESS","city":"HURLEY","state":"VA","zip":"24620-9998","dob":"1977-10-11","age":"","mstatus":"","insh":"10117141","cliId":"","pno":"6567256186","cno":"","email":"","ename":"","eno":"","pphy":"OWENS, DIA P","ppno":"2765977081          ","pcpadd":"185 Redwood Ave, Ste 102","pcpcity":"185 Redwood Ave, Ste 102","pcpstate":"VA","pcpzip":"242772599","pcpcounty":"","pcpid":"","pcpname":"HURLEY FAMILY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"3362 OLD GUESSES FORK RD","madd2":"","madd3":"","mcity":"HURLEY","mstate":"VA","mzip":"24620-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F15.20","F10.10","Z71.89","K92.1","R10.9","R07.89","R05","F17.210","Z20.822","J20.9","J44.1","M94.0","I10","R06.00","R11.2","R06.02","R07.81","R07.9","R53.83","R09.02","R00.0","Z11.59","F15.10","Z11.4","Z71.6","G47.00","R42","F17.200","Z03.818","K92.2","F10.129","K29.20","Z79.899","Z79.82","K29.21","F10.20","F32.A"],"date":["2022-03-30","2022-02-10","2022-02-10","2022-01-11","2021-04-16","2021-05-01","2021-04-16","2021-04-16","2021-05-01","2021-05-01","2020-06-12","2021-05-02","2020-06-12","2022-03-22","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2021-12-17","2021-05-01","2020-06-12","2021-10-22","2021-10-22","2021-10-22","2021-12-17","2021-11-17","2021-11-17","2021-11-17","2021-04-16","2021-05-01","2021-05-02","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2022-03-30","2022-03-30"],"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":[["","00054001829","PREDNISONE","TAB 20MG","10.00","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","14.00","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.50","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6.00","Select","Select",""],["","55111028050","LEVOFLOXACIN","TAB 500MG","7.00","Select","Select",""],["","00378773293","ONDANSETRON","TAB 4MG ODT","10.00","Select","Select",""],["","68001032205","BUPROPN","TAB 150MG XL","30.00","Select","Select",""],["","47335032688","NALTREXONE","TAB 50MG","30.00","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","10.00","Select","Select",""],["","00378633380","ACAMPRO","TAB 333MG","42.00","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":""}]}]}