{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CIN YORNOSLOH","gend":0,"add":"               NL YELOOC 60911                              ","city":"BUMPASS                       ","state":"VA","zip":"23024-8905","dob":"1961-08-17","age":"","mstatus":"","insh":"50016260","cliId":"","pno":"9304568245","cno":"","email":"","ename":"","eno":"","pphy":"ANSARI, NATHER B                                            ","ppno":5407859900,"pcpadd":"1075 GARRISONVILLE RD,Ste 115","pcpcity":"STAFFORD                      ","pcpstate":"VA","pcpzip":225568600,"pcpcounty":"","pcpid":"","pcpname":"SENIOR AND ADULT CARE LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"11906 COOLEY LN","madd2":"                                                            ","madd3":"","mcity":"BUMPASS                       ","mstate":"VA","mzip":"23024-8905","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N18.3","I12.9","Z90.5","R51","J44.9","S37.009A","F41.9","I10","E55.9","I25.10","I65.23","N18.4","E78.5","F17.210","G60.9","R60.0","J44.1","F41.1","I25.119","I65.29","I25.110","R94.39","I73.9","M79.605","R60.9","R06.02","R07.9","R07.89","R00.1","Z85.528","Z79.82","Z87.891","Z82.49","I20.0","I21.4","Y83.1","T82.855A","Z79.02","Z23","I65.21","N18.9","E87.5","S37.001A","Z01.810","Z11.59","E78.2","Z95.5","Z95.1","Z95.820","Z03.818","Z20.828","I13.10","Z95.828","Z83.3","N18.30","N18.31","Z48.812","I70.219","I70.213","M79.671","Z12.2"],"date":["2020-07-16","2021-08-12","2020-09-23","2019-01-07","2020-09-23","2019-01-07","2020-12-21","2021-12-14","2020-07-09","2020-09-23","2021-12-14","2020-09-23","2021-11-18","2020-09-23","2019-05-17","2019-08-22","2021-11-18","2021-11-18","2021-12-14","2021-11-18","2019-09-25","2020-06-23","2020-09-23","2019-09-21","2019-09-21","2019-09-23","2020-06-16","2019-09-23","2019-09-21","2020-09-23","2019-09-23","2021-12-18","2020-09-23","2019-09-23","2019-09-23","2019-09-23","2019-09-23","2020-06-23","2021-09-22","2020-09-23","2021-08-12","2020-07-09","2020-03-12","2020-06-16","2020-06-18","2021-12-14","2020-09-23","2020-06-23","2020-06-23","2020-09-18","2020-09-18","2020-09-23","2020-09-23","2020-09-23","2021-02-22","2021-08-12","2021-02-15","2021-03-05","2021-02-15","2021-11-18","2021-12-18"],"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":[["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","60505464303","PRASUGREL","TAB 10MG","90","Select","Select",""],["","64980029410","SODIUM","TAB 10GR","30","Select","Select",""],["","60505009600","DOXAZOSIN","TAB 8MG","30","Select","Select",""],["","50111032801","HYDRALAZINE","TAB 50MG","270","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","180","Select","Select",""],["","00456141030","BYSTOLIC","TAB 10MG","60","Select","Select",""],["","13668035530","NEBIVOLOL","TAB 10MG","60","Select","Select",""],["","27241012502","RANOLAZINE","TAB 500MG ER","60","Select","Select",""],["","13668010401","ISOSORB","TAB 30MG ER","90","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0.25","Select","Select",""],["","72205000490","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","00228203910","ALPRAZOLAM","TAB 2MG","90","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","17","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","12","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","28","Select","Select",""],["","29300012713","BISOPROL","TAB 10MG","30","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","20","Select","Select",""],["","49281012065","FLUZONE","INJ PF 20-21","0.7","Select","Select",""],["","00597003234","CATAPRES-TTS","DIS 0.2\/24HR","4","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","65862019899","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","46287000601","SPS","SUS 15GM\/60","120","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","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":""}]}]}