{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YELNATSTTELMAH","gend":0,"add":"          NL DAORLIAR 002                         ","city":"PAMPLIN                  ","state":"VA","zip":"23958-9998","dob":"1977-05-28","age":"","mstatus":"","insh":"10118337","cliId":"","pno":"4943432051","cno":5403438640,"email":"","ename":"","eno":"","pphy":"SWEET, MARY G","ppno":5405625700,"pcpadd":"1314 PETERS CREEK ROAD,","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":240172500,"pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY MEDICINE ROANOKE SALEM","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"200 RAILROAD LN                                   ","madd2":"                                                  ","madd3":"","mcity":"PAMPLIN                  ","mstate":"VA","mzip":"23958-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.9","R07.89","R07.9","F25.0","F41.9","R45.6","F79","S89.91XA","F31.9","I12.9","N18.30","Z78.9","R06.89","Z60.9","R79.1","R06.00","Z74.3","R94.31","I44.0","R07.2","F99","Z04.6","X58.XXXA","Y93.9","Y92.9","S80.211A","F17.210","Z20.828","R45.1","Z20.822","N18.32","F09","F06.8","R41.82","Z11.1","F91.8","F70","F25.9","Q84.6","L60.3","I10","E78.5","F31.81","B35.1","M79.674","M79.675","R26.2","M20.42"," "],"date":["2022-11-18","2021-07-31","2021-07-31","2022-11-22","2021-07-31","2021-07-31","2021-07-31","2021-03-12","2021-04-30","2021-07-31","2021-07-31","2021-04-16","2021-04-27","2022-11-18","2021-05-15","2021-05-15","2021-07-31","2021-04-27","2021-08-01","2021-05-14","2021-03-12","2021-03-12","2021-03-12","2021-03-12","2021-03-12","2021-03-12","2021-07-31","2021-03-12","2021-04-30","2021-04-30","2021-04-30","2021-03-12","2021-04-30","2021-04-30","2021-07-27","2021-07-31","2021-07-31","2021-08-01","2022-07-19","2022-09-01","2022-09-27","2022-09-27","2022-09-27","2022-09-01","2022-09-01","2022-09-01","2022-09-01","2022-09-01","2022-11-22"],"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":[["","71093014806","AMLODIPINE","TAB 10MG","28","Select","Select",""],["","00093729505","CARVEDILOL","TAB 12.5MG","56","Select","Select",""],["","23155050101","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","68382000801","LAMOTRIGINE","TAB 100MG","30","Select","Select",""],["","67457041013","HALOPER","INJ 50MG\/ML","1.00","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","56","Select","Select",""],["","60505257909","ATORVASTATIN","TAB 20MG","28","Select","Select",""],["","00603243821","BENZTROPINE","TAB 1MG","120","Select","Select",""],["","00832155011","HALOPERIDOL","TAB 10MG","15","Select","Select",""],["","65862070260","ZIPRASIDONE","CAP 20MG","40","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2.00","Select","Select",""],["","33342007107","OLANZAPINE","TAB 15MG","28","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":""}]}]}