{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"B   LEAHCIMNOSREFFEJ ","gend":0,"add":" 821TS A","city":"AUSTINVILLE","state":"VA","zip":"24312-9998","dob":"1993-12-23","age":"","mstatus":"","insh":"94000910*898","cliId":"","pno":"62\/6726615-6","cno":" ","email":"","ename":"","eno":"","pphy":"DOVE, SCOTTY DO","ppno":"276\/227-0460","pcpadd":"SUITE B 245 HOLSTON RD","pcpcity":"WYTHEVILLE","pcpstate":"VA","pcpzip":24382,"pcpcounty":"","pcpid":"","pcpname":"WYTHE COUNTY PHYSICIAN PRACTICES LLC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","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":["G47.33","F32.A","Z20.822","R04.0","E87.6","F90.9","Z79.899","E78.2","M19.90","J30.9","J34.0","Q81.9","R53.83","J06.9","Z51.6","F41.8","J30.1","J30.89","J30.81","F98.8","F41.9","R23.8","Z72.0","Z88.0","R52.","R06.83"],"date":["2022-10-24","2022-10-24","2022-02-11","2022-04-22","2022-04-22","2022-09-26","2022-04-22","2022-07-25","2022-10-19","2022-04-22","2022-04-22","2022-04-22","2022-02-11","2022-02-11","2022-09-15","2022-07-25","2022-11-02","2022-07-28","2022-07-28","2022-02-11","2022-02-11","2022-01-21","2022-02-11","2022-02-11","2022-02-11","2022-04-19"],"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":[["","29300041519","CYCLOBENZAPRINE HYDROCHLORIDE","TAB 10MG","90","Select","Select",""],["","43547028211","ESCITALOPRAM OXALATE","TAB 20MG","90","Select","Select",""],["","59417010410","VYVANSE","CAP 40MG","30","Select","Select",""],["","80777027399","MODERNA COVID-19 VACCINE","INJ COVID-19","0","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","SPR 50MCG","16","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","42806031250","DOXYCYCLINE HYCLATE","TAB 100MG","20","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","7","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","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":""}]}]}