{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M YKCIVSIRRAH ","gend":1,"add":"iaM N 71025 tpA tS n","city":"Danville                 ","state":"VA","zip":"24540-3200","dob":"1956-04-18","age":"","mstatus":"","insh":"10118349","cliId":"","pno":"8443406713","cno":"","email":"","ename":"","eno":"","pphy":"BADARACCO, MARIA C","ppno":5406613011,"pcpadd":"661 UNIVERSITY LN STE E,","pcpcity":"Orange","pcpstate":"VA","pcpzip":229602243,"pcpcounty":"","pcpid":"","pcpname":"UVA ORANGE DIALYSIS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2017 N Main St Apt 5","madd2":"","madd3":"","mcity":"Danville                 ","mstate":"VA","mzip":"24540-3200","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G89.4","E87.6","K59.00","K76.89","K76.0","M79.602","R60.1","K76.9","I27.0","R69","R07.89","M25.561","Z96.651","Z01.812","G56.22","G56.02","M79.642","H04.563","H25.13","I11.9","F17.200","I31.3","J98.11","J47.9","H02.88A","H04.562","H04.223","H25.813","R10.12"],"date":["2022-12-29","2022-05-26","2022-05-26","2022-05-26","2022-05-26","2022-05-26","2022-12-29","2022-05-26","2022-12-13","2022-12-01","2022-05-24","2022-07-18","2022-07-18","2022-05-26","2022-04-06","2022-04-06","2022-04-06","2022-11-23","2022-11-23","2022-05-24","2022-05-24","2022-05-24","2022-05-24","2022-05-24","2022-06-20","2022-10-24","2022-09-23","2022-09-23","2022-05-23"],"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":[["","00245036030","KLOR-CON","PAK 20MEQ","180","Select","Select",""],["","00093505898","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","16714008210","HYDROXYZ HCL","TAB 25MG","60","Select","Select",""],["","67877031901","IBUPROFEN","TAB 400MG","60","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","43547028950","BUPROPION","TAB 150MG SR","180","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","00574402435","ERYTHROMYCIN","OIN 5MG\/GM","3.5","Select","Select",""],["","00832532411","POT CL MICRO","TAB 10MEQ ER","180","Select","Select",""],["","68645059459","FAMOTIDINE","TAB 20MG","180","Select","Select",""],["","24208083060","NEO\/POLY\/DEX","SUS 0.1% OP","5","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":""}]}]}