{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YTTEBKNIF J ","gend":1,"add":"NIL 351EVA NED","city":"BROADWAY","state":"VA","zip":"22815-9998","dob":"1957-04-07","age":"","mstatus":"","insh":"75000910*858","cliId":"","pno":"7504555108","cno":5405780155,"email":"","ename":"","eno":"","pphy":"NIO, DEBORAH A MD","ppno":5404339151,"pcpadd":"1831 RESERVOIR ST","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":"22801-9998","pcpcounty":"","pcpid":"","pcpname":"Harrisonburg Family Practice Associates","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":["M79.672","M85.80","N18.32","I10.","D47.2","E78.9","E55.9","Z12.31","Z87.891","F17.210","N18.31","H25.13","E03.9","E78.5","Z00.00","J20.8","Z13.31","Z91.81","Z12.11","M20.42","M77.42","M77.52","M85.851","Z78.0"],"date":["2023-01-24","2022-12-09","2022-10-20","2022-10-25","2023-02-02","2022-10-25","2022-10-20","2022-11-08","2022-12-09","2022-12-09","2022-10-25","2022-09-30","2022-10-20","2022-10-20","2022-10-20","2022-05-11","2022-10-20","2022-10-20","2022-06-28","2023-01-24","2023-01-24","2023-01-24","2023-01-24","2023-01-24"],"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":[["","68382039801","POT CHLORIDE","TAB 20MEQ ER","30","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00228203196","ALPRAZOLAM","1 MG","90","Select","Select",""],["","65862078430","ESOMEPRA MAG","CAP 40MG DR","30","Select","Select",""],["","31722070290","LOSARTAN POT","TAB 100MG","30","Select","Select",""],["","16714017001","BUT\/APAP\/CAF","CAP","90","Select","Select",""],["","57237001830","DULOXETINE","CAP 30MG","30","Select","Select",""],["","65862017360","TOPIRAMATE","TAB 100MG","45","Select","Select",""],["","00093505998","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","00228203110","ALPRAZOLAM 1","MG ","90","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68645051554","AMLODIPINE BESYLATE","5 MG","90","Select","Select",""],["","00093505998","ATORVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","65862078430","ESOMEPRAZOLE MAGNESIUM","40 MG","90","Select","Select",""],["","31722070290","LOSARTAN POTASSIUM","100 MG","90","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":""}]}]}