{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"G AMLIWREMMAR","gend":1,"add":" GNIK 65491DR MAILLIW","city":"KING WILLIAM","state":"VA","zip":"23086-9998","dob":"1944-12-23","age":"","mstatus":"","insh":"10117763","cliId":"","pno":"8840840145","cno":"","email":"","ename":"","eno":"","pphy":"ROSE, ROBERT M","ppno":8047693096,"pcpadd":"1041 Sharon Rd Ste 205, ","pcpcity":"King William","pcpstate":"VA","pcpzip":230863344,"pcpcounty":"","pcpid":"","pcpname":"AYLETT MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"19456 KING WILLIAM RD","madd2":"","madd3":"","mcity":"KING WILLIAM","mstate":"VA","mzip":"23086-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R39.81","R15.9","R53.1","R53.83","E11.8","N18.30","E55.9","E07.9","Z00.00","E11.22","N18.6","E78.5","I10","G62.9","B37.0","J45.20","G47.00","F03.90","E13.9","R03.0","H10.33","F33.9","E11.628","L03.115","E11.621","E11.65","Y92.009","E11.40","L03.031","M65.9","I12.9","Z79.4","J45.909","F32.9","I25.2","N18.3","R56.9","M79.89","R09.02","S90.424A","L97.519","L08.9","X58.XXXA","R60.0","I25.10","Z01.810","F32.0","Z11.59","Z09","F33.41","E66.01","Z68.37","N18.4","R40.4","R32","M54.50","R26.81","R79.89","Z74.3","K21.9","K58.0","R63.0","R91.1","E78.00","F32.A","K58.9","R11.2","R41.82","I16.0","G93.41","R62.7","N18.9"],"date":["2022-04-05","2022-04-05","2022-04-24","2022-04-05","2022-04-04","2022-04-04","2021-10-26","2021-09-30","2021-01-07","2022-04-24","2022-02-12","2022-04-24","2022-04-24","2022-03-28","2021-01-07","2021-01-07","2021-06-11","2022-04-24","2021-10-28","2021-01-28","2022-02-12","2021-04-28","2020-06-09","2020-06-12","2020-06-03","2022-04-24","2020-06-03","2022-04-24","2020-06-23","2020-06-03","2022-04-24","2020-06-03","2022-04-24","2020-06-03","2020-06-03","2020-06-09","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-09","2020-06-03","2020-06-07","2022-04-24","2020-06-09","2022-03-28","2021-09-30","2020-06-22","2020-06-23","2022-04-24","2020-06-23","2021-10-26","2022-03-28","2022-04-07","2022-04-04","2022-03-28","2022-04-04","2022-04-24","2022-04-24","2022-04-24","2022-04-24","2022-04-24","2022-04-24","2022-04-24","2022-04-24","2022-04-24","2022-04-24","2022-04-24","2022-04-24","2022-04-24","2022-04-24"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"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":[["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","68462012605","GABAPENTIN","TAB 600MG","90","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","42858066045","FENOFIBRATE","TAB 160MG","33","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","9","Select","Select",""],["","00093727098","PRAVASTATIN","TAB 80MG","90","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","65862001105","SERTRALINE","TAB 25MG","90","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","12","Select","Select",""],["","00185093998","CHOLESTYRAM","POW 4GM LITE","180","Select","Select",""],["","59762040101","SUCRALFATE","TAB 1GM","360","Select","Select",""],["","64980028105","GLIPIZIDE","TAB 10MG","90","Select","Select",""],["","67877024201","QUETIAPINE","TAB 25MG","90","Select","Select",""],["","00006011231","JANUVIA","TAB 50MG","90","Select","Select",""],["","56151146001","TRUE","TES GLUCOSE","200","Select","Select",""],["","00406012405","HYDROCO\/APAP","TAB 7.5-325","30","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","15","Select","Select",""],["","65862020399","LOSARTAN","TAB 100MG","46","Select","Select",""],["","13107000130","MIRTAZAPINE","TAB 7.5MG","90","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00316022115","NYSTATIN","CRE 100000","15","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","1","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","00002879959","HUMALOG","INJ 100\/ML","15","Select","Select",""],["","62559049001","DIPHEN\/ATROP","TAB 2.5MG","30","Select","Select",""],["","00054350049","LIDOCAINE","SOL 2% VISC","300","Select","Select",""],["","56151210201","PEN  NEEDLES","MIS 31GX6MM","100","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","60505265401","TRAZODONE","TAB 100MG","90","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","00574402435","ERYTHROMYCIN","OIN 5MG\/GM","3.50","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":""}]}]}