{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ARABRABPETSE S","gend":1,"add":"   DAOR KROF SRETSEL 5416                         ","city":"GRUNDY                   ","state":"VA","zip":"24614-5534","dob":"1957-10-19","age":"","mstatus":"","insh":"20119700","cliId":"","pno":"3967204195","cno":2763128136,"email":"","ename":"","eno":"","pphy":"PATEL, DINKAR N","ppno":2769352148,"pcpadd":"1520 SLATE CREEK RD STE 101,","pcpcity":"Grundy","pcpstate":"VA","pcpzip":246146975,"pcpcounty":"","pcpid":"","pcpname":"TRI STATE CLINIC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"6145 LESTERS FORK ROAD                            ","madd2":"                                                  ","madd3":"","mcity":"GRUNDY                   ","mstate":"VA","mzip":"24614-5534","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R74.8","J44.9","I10","E87.6","I08.1","I27.20","R19.7","R06.03","M62.81","R11.0","F11.20","I95.9","R11.10","I20.0","Z99.81","Z74.3","A41.9","R65.21","I11.0","I50.9","I45.81","R10.84","R91.8","R06.00","N39.0","F17.210","Z20.822"," ","R53.1","R42","J11.89","J44.1","S39.012A","X58.XXXA","Y92.89","Y93.89","Y99.8","F17.200","Z79.891","M79.2","G89.29","R65.20","J96.21","J18.9","D72.829","D64.9","E83.42","R97.1","M81.0","E55.9","F41.9","F32.A","J96.00","K52.9","J15.0","R77.8","M54.50","M79.604","M79.605","Z91.14","G62.9","Z23","M54.9","M54.2","M25.551","R06.02"],"date":["2022-10-03","2022-11-09","2022-11-09","2022-10-27","2022-10-02","2022-10-02","2022-10-01","2022-10-04","2022-10-27","2022-10-04","2022-12-06","2022-10-27","2022-10-27","2022-10-03","2022-10-03","2022-10-03","2022-10-29","2022-10-27","2022-10-29","2022-10-29","2022-10-03","2022-10-05","2022-10-05","2022-12-09","2022-10-05","2022-10-27","2022-10-27","2022-12-11","2022-12-11","2022-12-11","2022-12-11","2022-11-22","2022-11-22","2022-11-22","2022-11-22","2022-11-22","2022-11-22","2022-11-29","2022-11-22","2022-11-29","2022-11-29","2022-10-29","2022-10-27","2022-10-27","2022-10-27","2022-10-27","2022-10-27","2022-10-27","2022-10-27","2022-10-27","2022-12-09","2022-11-09","2022-10-27","2022-10-03","2022-10-03","2022-10-03","2022-11-29","2022-11-15","2022-11-15","2022-12-09","2022-11-09","2022-11-09","2022-11-09","2022-11-09","2022-11-29","2022-10-27"],"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":[["","65862019399","FLUOXETINE","CAP 20MG","60","Select","Select",""],["","13107000334","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","42","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","56","Select","Select",""],["","00093227534","AMOX\/K","TAB 875-125","20","Select","Select",""],["","10702000610","CYCLOBENZAPR","TAB 5MG","20","Select","Select",""],["","68180050203","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00093100305","BUSPIRONE","TAB 15MG","90","Select","Select",""],["","00093078710","ATENOLOL","TAB 25MG","30","Select","Select",""],["","00093221005","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","00832532310","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","68180051202","LISINOPRIL","TAB 2.5MG","30","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","14","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","6.7","Select","Select",""],["","00832532510","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","68180030320","CEFUROXIME","TAB 500MG","6","Select","Select",""],["","29300022705","METRONIDAZOL","TAB 500MG","9","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","60","Select","Select",""],["","67877022410","GABAPENTIN","CAP 400MG","30","Select","Select",""],["","13668008130","MONTELUKAST","TAB 10MG","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":["",""],"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":{"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":""}]}]}