{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YHTOMITYEXAM W ","gend":0,"add":"CIRTAP 83921YWH YRNEH K","city":"PHENIX","state":"VA","zip":"23959-9998","dob":"1965-01-12","age":"","mstatus":"","insh":"93000910*908","cliId":"","pno":"16\/4347833-0","cno":"","email":"","ename":"","eno":"","pphy":"WALDRON, VINCENT MD","ppno":"434\/376-2325","pcpadd":"104 CAROLINA AVE","pcpcity":"BROOKNEAL","pcpstate":"VA","pcpzip":24528,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"","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":["I25.10","I73.9","I42.9","R00.2","E11.65","E11.9","M75.81","I42.8","E78.5","E78.49","M54.16","M65.811","I10.","M47.22","G89.4","Z51.81","Z23.","Z12.11"],"date":["2021-11-05","2020-10-01","2020-11-18","2020-10-01","2020-09-30","2021-09-22","2021-01-15","2021-01-15","2021-09-22","2021-09-22","2021-05-18","2021-01-15","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-05-23"],"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":{"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":[["","31722099601","HYDROCO\/APAP","TAB 5-325MG","90","Select","Select",""],["","69543012550","GLIMEPIRIDE","TAB 4MG","90","Select","Select",""],["","68645059090","CLOPIDOGREL","TAB 75MG","-90","Select","Select",""],["","43547028211","ESCITALOPRAM","TAB 20MG","90","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","-100","Select","Select",""],["","56151147002","TRUE","KIT METER","1","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","90","Select","Select",""],["","65162010211","GABAPENTIN","CAP 300MG","360","Select","Select",""],["","57237009001","TRANDOLAPRIL","TAB 2MG","90","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","90","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","-90","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","12","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","-180","Select","Select",""],["","68382009505","CARVEDILOL","TAB 25MG","180","Select","Select",""],["","00093505798","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","00832105415","BACLOFEN","TAB 10MG","90","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}