{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"S NORAHSTTELFFIH","gend":1,"add":"TTUB   2113ENAL YLFRE","city":"MCGAHEYSVILLE","state":"VA","zip":22840,"dob":"1964-10-11","age":"","mstatus":"","insh":"10118788","cliId":"","pno":"3804588700","cno":5407057772,"email":"","ename":"","eno":"","pphy":"HILL, JORDAN L","ppno":5408300788,"pcpadd":"2010 HEALTH CAMPUS DR,","pcpcity":"ROCKINGHAM","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":"","pcpname":"SRMH HOSPITALISTS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"Western\/Charlottesville","aligned":"Y","ano":"","add2":"","add3":"","madd1":"3112 BUTTERFLY LANE","madd2":"","madd3":"","mcity":"MCGAHEYSVILLE","mstate":"VA","mzip":"22840-2225","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["U07.1","J12.82","H25.012","H25.042","R63.0","E78.5","R53.81","E11.9","H25.13","H25.12","H25.11","Z96.1","F43.22","R07.89","F41.9","J44.9","M25.512","J40","E11.36","H25.812","Z88.1","Z91.02","Z88.5","Z91.011","Z88.2","Z79.899","Z79.84","F17.200","G89.29","M47.22","M54.2","M54.12","M48.02"," ","B34.9","Z20.828","M46.92"],"date":["2022-12-03","2022-02-03","2022-03-21","2022-04-14","2022-05-04","2022-05-04","2022-05-04","2022-09-26","2022-04-14","2022-05-11","2022-09-26","2022-09-26","2022-07-21","2022-05-04","2022-08-04","2022-08-04","2022-10-10","2022-10-10","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2022-10-10","2022-11-09","2022-11-09","2022-11-09","2022-11-09","2022-12-03","2022-02-04","2022-02-04","2022-11-09"],"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":[["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","150.00","Select","Select",""],["","59762372101","ALPRAZOLAM","TAB 1MG","90.00","Select","Select",""],["","70010006305","METFORMIN","TAB 500MG","74.00","Select","Select",""],["","65862050220","AMOX\/K","TAB 500-125","21","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","61314063705","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","00378543035","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","61314012605","KETOROLAC","SOL 0.005","5","Select","Select",""],["","68180047903","SIMVASTATIN","TAB 20MG","90.00","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","21.00","Select","Select",""],["","70954005920","PREDNISONE","TAB 10MG","3","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":""}]}]}