{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ENAIDETIHW","gend":1,"add":"DCM 0421DR LEINA","city":"JAVA","state":"VA","zip":"24565-9998","dob":"1952-11-11","age":"","mstatus":"","insh":"85000910*830","cliId":"","pno":"34\/4349138-2","cno":"434\/421-4508","email":"","ename":"","eno":"","pphy":"PICKERAL, ELIZABETH M NP","ppno":"434\/432-4443","pcpadd":"4 SOUTH MAIN STREET","pcpcity":"CHATHAM","pcpstate":"VA","pcpzip":24531,"pcpcounty":"","pcpid":"","pcpname":"PIEDMONT ACCESS TO HEALTH SERVICES INC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R25.1","R41.3","R56.9","E55.9","I10.","E11.9","G47.30","R06.83","E78.5","E11.65","E66.9","G47.00","R41.2","G93.89"],"date":["2022-05-25","2022-05-25","2022-05-25","2022-09-29","2022-09-07","2022-09-08","2022-07-26","2022-07-26","2022-09-08","2022-09-29","2022-09-07","2022-08-22","2022-08-22","2022-08-22"],"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":[["","68180011807","LEVETIRACETAM ER","TAB 750MG ER","30","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","TAB 10MG","90","Select","Select",""],["","62332002791","LOSARTAN POTASSIUM","TAB 25MG","90","Select","Select",""],["","70377002811","ATORVASTATIN CALCIUM","TAB 20MG","90","Select","Select",""],["","57664051083","MIRTAZAPINE","TAB 7.5MG","90","Select","Select",""],["","55111072901","ALLOPURINOL","TAB 100MG","180","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN","INJ FLEXPEN","15","Select","Select",""],["","67877056310","METFORMIN HYDROCHLORIDE","TAB 1000MG","180","Select","Select",""],["","53885024510","ONETOUCH ULTRA","TES ULTRA","100","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","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":""}]}]}