{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"B L YMANOTTIR","gend":1,"add":"OOG 346TS YBSL","city":"Marion","state":"VA","zip":"24354-9998","dob":"1976-05-15","age":"","mstatus":"","insh":"10111888","cliId":"","pno":"8767258110","cno":"","email":"","ename":"","eno":"","pphy":"STIEFEL, BRIAN H","ppno":2767837167,"pcpadd":"1020 TERRACE DR,","pcpcity":"Marion","pcpstate":"VA","pcpzip":"24354-4393","pcpcounty":"","pcpid":"","pcpname":"FAMILY PHYSICIANS OF MARION\/","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"APT 11","add3":"","madd1":"643 GOOLSBY ST","madd2":"APT 11","madd3":"","mcity":"Marion","mstate":"VA","mzip":"24354-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.31","L60.0","B35.1","M79.674","M20.11","F25.9","R21","F31.10","F32.A","F41.9","D49.9","R05.9","H66.92","L03.031","H40.013","R03.0","R10.9","R10.13","E55.9","Z79.899","L25.9","Z12.39","K64.4"],"date":["2022-03-16","2022-11-21","2022-11-21","2022-11-21","2022-10-25","2023-06-29","2022-05-31","2023-06-06","2022-08-08","2022-08-08","2022-08-03","2022-08-03","2022-03-15","2022-11-21","2022-09-26","2022-09-26","2022-11-29","2023-01-06","2023-01-06","2023-01-06","2023-04-13","2023-04-13","2023-05-24"],"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":[["","00378668977","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","67877043403","ARIPIPRAZOLE","TAB 20MG","30","Select","Select",""],["","16729000517","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","31722072250","LEVOFLOXACIN","TAB 500MG","7","Select","Select",""],["","51672400501","CARBAMAZEPIN","TAB 200MG","120","Select","Select",""],["","43547028110","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","30","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","70700015010","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","55111025960","ZIPRASIDONE","CAP 80MG","180","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","29033000305","SUCRALFATE","TAB 1GM","60","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00115180301","HYDROXYZ","CAP 25MG","30","Select","Select",""],["","00378668977","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","00781185220","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","67877043403","ARIPIPRAZOLE TAB","20MG","30","Select","Select",""],["","16729000517","SIMVASTATIN TAB","20MG","90","Select","Select",""],["","31722072250","LEVOFLOXACIN TAB","500MG","7","Select","Select",""],["","51672400501","CARBAMAZEPIN TAB","200MG","120","Select","Select",""],["","43547028110","ESCITALOPRAM TAB","10MG","30","Select","Select",""],["","00115180301","HYDROXYZ PAM CAP","25MG","30","Select","Select",""],["","00093083205","CLONAZEPAM TAB","0.5MG","30","Select","Select",""],["","70700015010","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","55111025960","ZIPRASIDONE CAP","80MG","180","Select","Select",""],["","00093314705","CEPHALEXIN CAP","500MG","30","Select","Select",""],["","29033000305","SUCRALFATE TAB","1GM","60","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":""}]}]}