{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"R HTENNEKNAMLLID ","gend":0,"add":"        LIART NOISSIM 481                         ","city":"ROSE HILL                ","state":"VA","zip":"24281-9998","dob":"1959-07-27","age":"","mstatus":"","insh":"10118421","cliId":"","pno":"0267230646","cno":2762064877,"email":"","ename":"","eno":"","pphy":"COUCH, JILL","ppno":2765463001,"pcpadd":"276 FIELDSTONE DR,STE 2037","pcpcity":"Jonesville","pcpstate":"VA","pcpzip":242631215,"pcpcounty":"","pcpid":"","pcpname":"JONESVILLE FAMILY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"184 MISSION TRAIL                                 ","madd2":"                                                  ","madd3":"","mcity":"ROSE HILL                ","mstate":"VA","mzip":"24281-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.2","I70.203","E11.9","C91.10","N18.32","E11.8","C91.90","I70.91","E11.65","E78.2","I73.9","I10","H61.23","R53.83","N40.0","E55.9","L30.9","I15.8","Z00.8","Z12.11","Z13.89","Z13.9","Z71.89","M79.643","H54.8","Z86.718","Z79.4","B34.2","Z09","T78.40XA","M62.81","R53.1","I82.3","Z51.81","Z79.899","Z87.891","M79.604","M79.606","M79.651","S86.999D","I12.9","K21.9","Z79.01","Z95.820","M50.30","R07.2","R07.89","R07.9","R68.83","I16.0","L90.5","I65.23","H55.01","H25.813","H52.03","H52.223","H52.4","E87.2","E87.8","H93.12","E11.59","I25.10","E11.42","E11.319","E11.21","E78.5","C91.11","H90.3","I44.7","R94.31","R11.0"," ","E11.22","R42","E11.51","E87.5","N18.31"],"date":["2022-07-16","2021-01-05","2022-08-10","2022-08-22","2022-12-02","2022-12-02","2022-12-02","2022-06-14","2022-11-17","2022-05-17","2022-08-10","2022-10-08","2020-02-10","2022-05-17","2022-02-15","2021-09-28","2020-03-05","2020-11-10","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2020-05-13","2021-09-28","2022-12-07","2022-08-10","2020-07-01","2020-07-07","2021-09-28","2022-10-08","2022-07-16","2022-07-16","2022-08-22","2021-10-01","2021-10-01","2021-08-01","2021-08-01","2021-08-01","2021-08-03","2022-12-02","2021-08-16","2022-12-07","2021-08-16","2021-09-28","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2020-11-10","2020-11-10","2021-12-21","2022-06-22","2022-06-22","2022-06-22","2022-06-22","2022-06-22","2022-07-27","2022-07-12","2022-07-12","2022-06-22","2022-06-22","2022-06-22","2022-06-22","2022-08-10","2022-06-22","2022-06-22","2022-08-23","2022-07-16","2022-07-13","2022-10-08","2022-12-07","2022-07-16","2022-07-16","2022-07-16","2022-11-22","2022-11-17"],"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":[["","43547040011","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","57237012501","WARFARIN","TAB 6MG","30","Select","Select",""],["","65862006499","METOPROL","TAB 100MG","60","Select","Select",""],["","00054004421","CILOSTAZOL","TAB 100MG","60","Select","Select",""],["","62037056001","POT  CHLORIDE","CAP 10MEQ ER","120","Select","Select",""],["","50111032703","HYDRALAZINE","TAB 25MG","90","Select","Select",""],["","62332000191","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","62175013643","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","43547035611","LISINOPRIL","TAB 40MG","30","Select","Select",""],["","68180046707","LOVASTATIN","TAB 10MG","90","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","29300039810","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","60","Select","Select",""],["","00310051260","CALQUENCE","CAP 100MG","56.00","Select","Select",""],["","68382080510","TRAZODONE","TAB 50MG","90","Select","Select",""],["","57962014012","IMBRUVICA","CAP 140MG","60","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","15","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","45","Select","Select",""],["","53885014301","ONETOUCH","MIS LANCETS","100","Select","Select",""],["","45802005536","TRIAMCINOLON","OIN 0.001","80","Select","Select",""],["","57237009960","CEFDINIR","CAP 300MG","20","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","57237003105","AMOXICILLIN","CAP 500MG","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":["",""]}},{"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":""}]}]}