{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NOTSNIWNITRAM ","gend":0,"add":"   DR NWOT YELKAOC   2461                         ","city":"DAYTON                   ","state":"VA","zip":"22821-9998","dob":"1994-07-11","age":"","mstatus":"","insh":"10118661","cliId":"","pno":"2404569251","cno":"","email":"","ename":"","eno":"","pphy":"PENCE, ROBERT P","ppno":5408792585,"pcpadd":"15 KILLDEER LN,","pcpcity":"Dayton","pcpstate":"VA","pcpzip":228219745,"pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY MEDICINE DAYTON","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"1642   COAKLEY TOWN RD                            ","madd2":"                                                  ","madd3":"","mcity":"DAYTON                   ","mstate":"VA","mzip":"22821-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F84.0","F80.2","F63.81","F39","R63.6","R47.82","F41.9","Z51.81","R79.9","Z13.1","R63.4","B35.1","L74.513","Z00.00","J34.89","Z11.1","Z11.59","Z20.828","R46.89"," "],"date":["2022-11-02","2020-09-15","2022-11-02","2022-11-02","2022-06-20","2022-06-20","2022-11-02","2022-11-30","2021-08-17","2021-03-19","2021-04-26","2021-10-26","2021-08-16","2022-06-20","2020-09-04","2020-09-23","2020-10-26","2020-10-26","2022-06-20","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":[["","65862037505","ESCITALOPRAM","TAB 20MG","28","Select","Select",""],["","27241000150","RISPERIDONE","TAB 1MG","28","Select","Select",""],["","45802014167","CICLOPIROX","SOL 0.08","6.6","Select","Select",""],["","51991070505","ALPRAZOLAM","TAB 0.5MG","15","Select","Select",""],["","51991052633","TERBINAFINE","TAB 250MG","19","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","0.5","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":""}]}]}