{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"R A NAESDLEFNESO","gend":0,"add":"     RET EKAL REVLIS 1042                         ","city":"MIDLOTHIAN               ","state":"VA","zip":"23112-9998","dob":"1984-06-08","age":"","mstatus":"","insh":"10117509","cliId":"","pno":"8840818197","cno":"","email":"","ename":"","eno":"","pphy":"LAURA CRITTENDEN TOOMBS MD","ppno":8045848898,"pcpadd":"7800 REEDY BRANCH RD,","pcpcity":"Chesterfield","pcpstate":"VA","pcpzip":238385705,"pcpcounty":"","pcpid":"","pcpname":"TOOMBS MD PLLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"2401 SILVER LAKE TER                              ","madd2":"                                                  ","madd3":"","mcity":"MIDLOTHIAN               ","mstate":"VA","mzip":"23112-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B34.9","M79.10","R05.9","R11.2","F17.200","Z20.822","F11.20","F14.10","Z13.89","Z51.81","L02.512","Z86.73","S76.011A","M25.551","X58.XXXA","Y93.55","Z79.1","Z79.82","Z79.899","R52","Y92.89","Y93.89","U07.1","J02.9","M79.604","M79.605","R60.0","Z86.718","R07.9","M79.89","R60.9","Z82.49","L02.414","H92.01"," "],"date":["2022-02-25","2022-02-25","2022-02-25","2022-02-25","2022-02-25","2022-02-25","2022-11-30","2022-09-06","2022-03-11","2022-03-11","2022-03-13","2022-08-17","2022-04-16","2022-04-16","2022-04-16","2022-04-16","2022-04-16","2022-04-16","2022-04-16","2022-02-25","2022-04-16","2022-04-16","2022-05-23","2022-05-23","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-08-17","2022-08-17","2022-08-17","2022-08-17","2022-05-05","2022-05-05","2022-11-30"],"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":[["","65162019050","NAPROXEN","TAB 500MG","14","Select","Select",""],["","76385012450","METHOCARBAM","TAB 750MG","20","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","14.00","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","270","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","5","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","6.7","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","60.00","Select","Select",""],["","65862049501","QUETIAPINE","TAB 400MG","30.00","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","14.00","Select","Select",""],["","00781532531","BROMOCRIPTIN","TAB 2.5MG","28.00","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","15.00","Select","Select",""],["","00093216568","NALOXONE","SPR 4MG","2","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","3","Select","Select",""],["","62332031631","DESIPRAMINE","TAB 25MG","90.00","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14.00","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","21.00","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","20.00","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":""}]}]}