{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L ARDNASYNOHTNA ","gend":1,"add":"          DAOR  TRUH 3241                         ","city":"BROOKNEAL                ","state":"VA","zip":"24528-9998","dob":"1954-08-10","age":"","mstatus":"","insh":"20111610","cliId":"","pno":"5843463166","cno":"","email":"","ename":"","eno":"","pphy":"DEHLI, TODD H","ppno":8043763717,"pcpadd":"633 COOK AVE,","pcpcity":"Brookneal","pcpstate":"VA","pcpzip":245283126,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"1423 HURT  ROAD                                   ","madd2":"                                                  ","madd3":"","mcity":"BROOKNEAL                ","mstate":"VA","mzip":"24528-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","R06.00","R05.9","J02.0","I50.22","I11.0","I25.10","G47.33","E78.5","I10","E11.9","R05.1","K04.7","R20.2","Z95.5","I21.4","I49.9","R09.89","R06.89","I51.7","I50.9"," "],"date":["2022-10-01","2022-10-01","2022-10-01","2022-10-01","2022-10-01","2022-09-19","2022-09-19","2022-09-19","2022-09-19","2022-09-19","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-12","2022-10-01"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":[["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00378021610","FUROSEMIDE","TAB 40MG","7","Select","Select",""],["","68180097401","LEVOTHYROXIN","TAB 175MCG","90","Select","Select",""],["","00378395377","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","62175030246","RABEPRAZOLE","TAB 20MG","90","Select","Select",""],["","00169255013","TRESIBA","INJ 200UNIT","9","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","120","Select","Select",""],["","50111064802","FLUOXETINE","CAP 20MG","270","Select","Select",""],["","56151211301","PEN  NEEDLES","MIS 31GX8MM","300","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","30","Select","Select",""],["","68308015260","NYSTATIN","POW 100000","120","Select","Select",""],["","45963070911","METOPROL","TAB 25MG ER","30","Select","Select",""],["","53489011902","DOXYCYCL","CAP 100MG","14","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":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}