{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NEHPETSGREBMULB","gend":0,"add":"         DR REVIR EYT 653                         ","city":"ARRINGTON                ","state":"VA","zip":"22922-9998","dob":"1957-06-24","age":"","mstatus":"","insh":"20116310","cliId":"","pno":"1243475245","cno":"","email":"","ename":"","eno":"","pphy":"KALAFIAN, MICHAEL J","ppno":4342003908,"pcpadd":"125 NATIONWIDE DR,STE 100","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245024272,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"356 TYE RIVER RD                                  ","madd2":"                                                  ","madd3":"","mcity":"ARRINGTON                ","mstate":"VA","mzip":"22922-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I21.3","M96.1","M54.50","R29.90","R53.1","R20.0","R51.9","E66.9","Z68.33","R20.8","Z53.29","M62.81","R29.898","R29.818","I65.23","R42","E11.9","I48.91","E78.00","J39.8","I25.10","Z79.899","Z79.4","F17.210","I63.89","I67.82","Z72.0","E87.1","E11.65","F41.9","I25.2","R00.2","R26.2","I63.9"," "],"date":["2022-12-04","2022-11-11","2022-10-11","2022-10-11","2022-10-13","2022-10-12","2022-10-12","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-12","2022-10-11","2022-10-11","2022-10-11","2022-10-12","2022-10-12","2022-10-13","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-13","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-13","2022-12-04"],"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":[["","10702005601","OXYCODONE","TAB 10MG","180","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","360","Select","Select",""],["","00002144509","TALTZ","INJ 80MG\/ML","3","Select","Select",""],["","70377003012","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","00093106101","SOTALOL","TAB 80MG","180","Select","Select",""],["","13668010510","ISOSORB","TAB 60MG ER","90","Select","Select",""],["","68180023209","FENOFIBRATE","TAB 160MG","90","Select","Select",""],["","62332002791","LOSARTAN","TAB 25MG","90","Select","Select",""],["","71093011105","GABAPENTIN","TAB 600MG","270","Select","Select",""],["","8290320550","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","24979070406","DEXLANSOPRAZ","CAP 60MG DR","90","Select","Select",""],["","65702071110","ACCU-CHEK","TES GUIDE","50","Select","Select",""],["","00169369619","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","500","Select","Select",""],["","45802012935","HALOBETASOL","CRE 0.0005","45","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":""}]}]}