{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"J NNYLNOSNHO","gend":0,"add":"VAD 21NL SI","city":"Farmville","state":"VA","zip":"23901-9998","dob":"1979-08-18","age":"","mstatus":"","insh":"10115850","cliId":"","pno":"0643490917","cno":4343913501,"email":"","ename":"","eno":"","pphy":"BONAGIRI, VARA P","ppno":4343929000,"pcpadd":"1400 MILNWOOD RD,PO BOX R","pcpcity":"Farmville","pcpstate":"VA","pcpzip":"23901-2579","pcpcounty":"","pcpid":"","pcpname":"FARMVILLE INTERNAL MEDICINE PC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"PO BOX 856","madd2":"","madd3":"","mcity":"Farmville","mstate":"VA","mzip":"23901-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.9","F25.1","M20.41","M20.42","B35.1","B35.3","M79.674","M79.675","E11.40","Z20.828","Z79.899","T50.995A","S09.90XA","Z04.89","R45.4","F17.200","O16.9","T50.905A","E46","G47.00","R51.9","R06.00","R05","R06.7","G58.8","I10","F29","R41.82","K21.9","F17.210","Z20.822","Z72.0","J30.2","Z68.24","S61.511A","W26.8XXA","Y92.89","F25.9","F15.20","F12.20"],"date":["2021-08-06","2021-08-16","2021-06-03","2020-12-21","2020-12-21","2020-12-21","2021-06-03","2020-12-21","2020-12-21","2020-12-22","2021-08-06","2021-04-09","2021-08-06","2021-08-09","2021-08-09","2021-08-09","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2020-12-22","2020-12-22","2020-12-22","2020-12-22","2021-06-03","2020-10-29","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-06-22","2021-06-22","2021-06-22","2021-07-10","2021-07-10","2021-07-10","2021-08-08","2021-08-08","2021-08-08"],"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":[["","50458056301","INVEGA SUST","INJ 156MG\/ML","1","Select","Select",""],["","00093321915","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","70436005901","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","69097082707","BENZTROPINE","TAB 1MG","30","Select","Select",""],["","14539067501","HYDROXYZ PAM","CAP 50MG","30","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","30","Select","Select",""],["","65862059501","DIVALPROEX","TAB 500MG ER","30","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","180","Select","Select",""],["","50458056301","INVEGA","INJ 156MG\/ML","1","Select","Select",""],["","14539067501","HYDROXYZ","CAP 50MG","30","Select","Select",""],["","50458056301","INVEGA SUST INJ","156MG\/ML","1","Select","Select",""],["","69097082707","BENZTROPINE TAB","1MG","30","Select","Select",""],["","70436005901","BUPROPION TAB","150MG SR","30","Select","Select",""],["","65862059501","DIVALPROEX TAB","500MG ER","30","Select","Select",""],["","14539067501","HYDROXYZ PAM CAP","50MG","30","Select","Select",""],["","16571020210","DICLOFENAC TAB","50MG DR","30","Select","Select",""],["","65862085901","FAMOTIDINE TAB","20MG","180","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":""}]}]}