{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ASERETYREWOL L","gend":1,"add":"IKREP 2311DR LLIM SN","city":"DILLWYN","state":"VA","zip":"23936-9998","dob":"1957-07-19","age":"","mstatus":"","insh":"85000910*858","cliId":"","pno":"4443426855","cno":"434\/445-5862","email":"","ename":"","eno":"","pphy":"BLACKWELL, BRIAN K MD","ppno":4345813271,"pcpadd":"25892 N JAMES MADISON HWY,","pcpcity":"NEW CANTON","pcpstate":"VA","pcpzip":"23123-9998","pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","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":["M54.12","I10.","R73.09","E55.9","E78.2","Z71.89","Z71.3","M72.2","D49.2","H91.93","Z23.","M79.674","M79.671","M54.10","M54.2","M50.30","M79.601","I44.7","L57.8","L82.1","L91.8"],"date":["2022-11-21","2023-01-04","2022-12-28","2022-12-28","2023-01-04","2022-07-26","2022-07-26","2022-07-26","2022-07-26","2022-07-26","2022-07-26","2022-07-18","2022-07-18","2022-10-26","2022-11-04","2022-11-04","2022-11-04","2023-01-04","2023-02-23","2023-02-23","2023-02-23"],"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":[]},{"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":[["","68180097903","LISINOPRIL","40 MG","90","Select","Select",""],["","58160081912","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","52817032000","BACLOFEN","TAB 10MG","90","Select","Select",""],["","50228017910","GABAPENTIN","CAP 100MG","20","Select","Select",""],["","51660033301","ARTHRTS PAIN","TAB 650MG","30","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","10","Select","Select",""],["","60505530701","ACYCLOVIR 800","MG ","30","Select","Select",""],["","60505530701","ACYCLOVIR","800 MG","30","Select","Select",""],["","68180097903","LISINOPRIL TAB","40MG","90","Select","Select",""],["","16729018317","HYDROCHLOROT TAB","25MG","90","Select","Select",""],["","58160081912","SHINGRIX INJ","50\/0.5ML","1","Select","Select",""],["","16571020150","DICLOFENAC TAB","75MG DR","60","Select","Select",""],["","60505530701","ACYCLOVIR TAB","800MG","30","Select","Select",""],["","52817032000","BACLOFEN TAB","10MG","90","Select","Select",""],["","50228017910","GABAPENTIN CAP","100MG","20","Select","Select",""],["","51660033301","ARTHRTS PAIN TAB","650MG","30","Select","Select",""],["","00093031401","KETOROLAC TAB","10MG","10","Select","Select",""],["","00172208380","HYDROCHLOROTHIAZIDE","25 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":""}]}]}