{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" MAILLIWLLAHSRAM","gend":0,"add":"LDNIK 4301EVIRD GNI","city":"FOREST","state":"VA","zip":"24551-3583","dob":"1970-05-27","age":"","mstatus":"","insh":"50019876","cliId":"","pno":"2243462551","cno":"","email":"","ename":"","eno":"","pphy":"BRELAND, DANIEL MATTHEW","ppno":2073237337,"pcpadd":"1613 Oakwood St, ","pcpcity":"Bedford","pcpstate":"VA","pcpzip":245231213,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"1034 KINDLING DRIVE","madd2":"","madd3":"","mcity":"FOREST","mstate":"VA","mzip":"24551-3583","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C90.00","D47.2","E88.09","R68.89","J20.8","R06.02","J96.21","E87.4","R65.10","Z94.84","N17.9","E87.1","G62.0","N18.3","Z99.81","C90.01","J45.909","E87.6","F32.9","I12.9","J44.9","I51.7","J96.01","J98.01","R09.02","R06.03","E87.2","I10","I34.0","G62.9","D75.9","R09.89","F41.9","M85.80","Z91.81","Z79.82","M89.9","R26.81","D64.9","Z23","R52","R55","R40.20","R06.89","R53.1","R94.31","F10.129","E86.0","E87.8","N18.30","D75.1","K52.9","J96.11","S00.01XA","M54.2","I36.1","F10.929","E53.8","E55.9","A41.4","A04.72","E44.0","M62.82","Z20.822","E83.42","E83.39","E83.51","G47.00","D72.819","Z85.79","Z88.8","Z79.899","A41.89","R19.7","Z87.898","I49.8","R26.2","T45.1X5A","M62.830","F10.10","G83.10","C79.51","M62.838","F10.11","R29.898","T45.1X5D","M15.0","F41.1","D80.1","M85.88","Z01.812","D69.6","F32.A","M54.50","M19.90","M48.061","R06.09","R06.00","M47.816","M54.5","M51.36","F41.0"],"date":["2022-03-17","2020-02-05","2022-03-10","2021-01-05","2020-02-10","2020-02-10","2021-08-31","2020-02-10","2020-02-12","2021-08-31","2020-03-02","2021-06-07","2022-04-03","2020-03-02","2020-02-10","2022-04-06","2020-03-02","2022-04-06","2022-04-03","2022-04-03","2021-08-31","2020-02-10","2020-02-12","2020-02-12","2022-02-18","2020-02-10","2021-05-18","2021-06-07","2020-02-11","2021-06-07","2020-02-13","2020-02-13","2022-04-03","2021-07-01","2020-03-02","2021-05-11","2020-07-16","2020-09-01","2022-03-10","2021-11-09","2021-05-11","2021-03-15","2021-03-14","2021-06-06","2021-06-07","2021-03-15","2021-03-14","2021-03-15","2021-05-18","2022-04-03","2021-03-15","2022-04-04","2021-07-01","2021-03-14","2021-05-11","2021-03-15","2021-03-15","2022-04-03","2021-12-28","2021-05-11","2022-04-06","2021-05-11","2021-05-18","2021-05-11","2022-04-06","2022-04-03","2021-05-12","2022-04-03","2021-05-18","2021-06-06","2022-04-03","2022-04-03","2021-05-18","2021-05-14","2021-05-18","2021-05-25","2021-06-08","2021-06-06","2021-06-06","2021-06-06","2021-06-06","2021-06-06","2021-06-07","2021-06-07","2021-06-07","2021-07-01","2021-07-01","2021-08-31","2021-09-07","2021-10-18","2022-03-10","2022-04-03","2022-04-03","2022-04-04","2022-04-03","2022-04-05","2019-05-22","2019-04-18","2019-10-14","2019-10-14","2019-10-14","2019-11-04"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","59572040528","REVLIMID","59572040528 REVLIMID ","28","Select","Select",""],["","68462016405","CARVEDILOL","68462016405 CARVEDILOL ","60","Select","Select",""],["","69680011225","CYANOCOBALAM","69680011225 CYANOCOBALAM ","4","Select","Select",""],["","27241009990","DULOXETINE","27241009990 DULOXETINE ","30","Select","Select",""],["","68382080610","TRAZODONE","68382080610 TRAZODONE ","75","Select","Select",""],["","68382018305","BUSPIRONE","68382018305 BUSPIRONE ","60","Select","Select",""],["","67877019810","AMLODIPINE","67877019810 AMLODIPINE ","90","Select","Select",""],["","16729018317","HYDROCHLOROT","16729018317 HYDROCHLOROT ","90","Select","Select",""],["","53746010901","HYDROCO\/APAP","53746010901 HYDROCO\/APAP ","10","Select","Select",""],["","00832532510","POT  CL MICRO","00832532510 POT  CL MICRO","10","Select","Select",""],["","69097081507","GABAPENTIN","69097081507 GABAPENTIN ","180","Select","Select",""],["","08290309581","3ML","MIS 25GX1\"","2.00","Select","Select",""],["","59267100001","PFIZER","59267100001 PFIZER ","0.3","Select","Select",""],["","00832532310","POT  CHLORIDE","TAB 10MEQ ER","20","Select","Select",""],["","13107008801","METHADONE","TAB 5MG","60","Select","Select",""],["","62559039050","VANCOMYCIN","62559039050 VANCOMYCIN ","20","Select","Select",""],["","43547030303","ARIPIPRAZOLE","43547030303 ARIPIPRAZOLE ","30","Select","Select",""],["","80681000400","OYSTER","80681000400 OYSTER ","60","Select","Select",""],["","43547035050","PAROXETINE","TAB 40MG","30","Select","Select",""],["","29300016815","TIZANIDINE","TAB 2MG","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":""}]}]}