{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"T T RETLAWRJ DNESNWO","gend":0,"add":"       LLIH NOTNUATS 0941                         ","city":"BROOKNEAL                ","state":"VA","zip":"24528-9998","dob":"1966-11-04","age":"","mstatus":"","insh":"10117680","cliId":"","pno":"7343433826","cno":"","email":"","ename":"","eno":"","pphy":"THOMPSON, JAMES","ppno":5404279200,"pcpadd":"2145 MOUNT PLEASANT BLVD SE,","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240143632,"pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY MEDICINE SOUTHEAST FAMILY MEDICAL","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"1490 STAUNTON HILL                                ","madd2":"                                                  ","madd3":"","mcity":"BROOKNEAL                ","mstate":"VA","mzip":"24528-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","I10","E66.01","Z68.42","K29.70","Z71.89","Z71.3","R74.01","R93.9","R93.89","G47.33","M24.572","M19.072","M77.52","B18.2","Z71.6","Z12.11","H40.013","Z87.828","S82.892A","M19.172","M25.572","F10.129","E66.9","W19.XXXA","S82.432A","W01.0XXA","E78.5","Z87.891","S82.839A","S82.65XA","S82.65XD","N19","Z12.5","Z13.220","Z13.1","Z23","B35.4"," "],"date":["2022-06-10","2022-06-10","2022-06-10","2021-01-05","2021-01-05","2021-01-05","2021-09-10","2022-01-10","2022-01-10","2020-01-17","2020-01-17","2021-05-07","2021-06-28","2021-04-26","2020-02-18","2020-02-18","2022-06-10","2020-06-26","2020-06-26","2021-05-07","2021-06-28","2020-09-14","2020-07-12","2020-07-12","2020-07-12","2020-07-12","2020-07-12","2020-07-12","2020-07-12","2020-07-12","2020-07-20","2020-09-14","2022-06-10","2022-06-10","2021-09-10","2022-06-10","2022-06-10","2022-06-10","2022-06-10"],"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":[["","67877019910","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","70377000215","SIMVASTATIN","TAB 10MG","30","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","49483062401","METFORMIN","TAB 750MG ER","180","Select","Select",""],["","70461032003","FLUCLVX","INJ 2020-21","0.5","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA","50","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","1.5","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","68462018135","CLOTRIMAZOLE","CRE 0.01","30","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}