{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  SELRAHCHSUBYAM W","gend":0,"add":"AH 304EVA SY","city":"STAUNTON","state":"VA","zip":"24401-9998","dob":"1976-11-29","age":"","mstatus":"","insh":"83000910*300","cliId":"","pno":"9204555644","cno":5408850861,"email":"","ename":"","eno":"","pphy":"MANN, LEIGH T PA","ppno":5408853525,"pcpadd":"SUITE 522 40 LAMBERT ST","pcpcity":"STAUNTON","pcpstate":"VA","pcpzip":"24401-9998","pcpcounty":"","pcpid":"","pcpname":"Carilion Healthcare Corp","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":["R35.0","R73.9","I10.","Z23.","M79.672","R22.42","R56.9","F79.","Z68.35","R73.09","B37.2","G40.909","Z13.220","R26.89","Z87.81","M85.862","F73.","R39.81","R15.9","J10.1","E86.0","N17.9","R50.9","Z20.822","G80.9","Z79.899","Z88.8","R53.1","E11.9","M10.9","M79.675","B36.0","R79.89","R09.89","E78.5","M1A.9XX1","L03.032","J06.9","L02.612","E79.0","Z87.39"],"date":["2021-02-26","2023-01-27","2023-01-27","2022-11-23","2022-08-08","2022-08-08","2022-08-18","2023-01-27","2022-08-18","2021-01-12","2020-04-23","2022-11-06","2021-12-13","2022-08-03","2022-08-03","2022-08-03","2021-06-14","2020-04-29","2020-04-29","2022-11-06","2022-11-06","2022-11-06","2022-11-06","2022-11-06","2022-11-06","2022-11-06","2022-11-06","2022-11-06","2022-11-18","2022-11-18","2022-11-18","2023-01-27","2022-01-21","2022-08-24","2023-01-27","2023-02-01","2022-11-14","2022-11-14","2022-11-14","2023-05-05","2023-02-01"],"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":[["","65862031560","LEVETIRACETA","TAB 1000MG","180","Select","Select",""],["","00054429731","FUROSEMIDE","20 MG","90","Select","Select",""],["","43547035311","LISINOPRIL","10 MG","90","Select","Select",""],["","69097086107","ZONISAMIDE","CAP 100MG","360","Select","Select",""],["","00093321205","CLONAZEPAM","1 MG","75","Select","Select",""],["","68462011060","TOPIRAMATE","200 MG","60","Select","Select",""],["","57237000511","FLUCONAZOLE","150 MG","8","Select","Select",""],["","68682065520","DIAZEPAM","GEL 20MG","1","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","31722063231","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","00093321205","CLONAZEPAM 1","MG ","75","Select","Select",""],["","00093321205","CLONAZEPAM TAB","1MG","75","Select","Select",""],["","00054429731","FUROSEMIDE TAB","20MG","-90","Select","Select",""],["","43547035311","LISINOPRIL TAB","10MG","-90","Select","Select",""],["","47335071213","TOPIRAMATE TAB","200MG","-60","Select","Select",""],["","69097086107","ZONISAMIDE CAP","100MG","360","Select","Select",""],["","65862031560","LEVETIRACETA TAB","1000MG","180","Select","Select",""],["","65862031560","LEVETIRACETAM","1000 MG","180","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","-4","Select","Select",""],["","68682065520","DIAZEPAM GEL","20MG","1","Select","Select",""],["","65862018730","ONDANSETRON TAB","4MG","12","Select","Select",""],["","00093314705","CEPHALEXIN CAP","500MG","-40","Select","Select",""],["","31722063231","OSELTAMIVIR CAP","75MG","10","Select","Select",""],["","59651045501","COLCHICINE","0.6 MG","90","Select","Select",""],["","29300035005","ALLOPURINOL","300 MG","90","Select","Select",""],["","45802046564","KETOCONAZOLE","2 %","120","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":""}]}]}