{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"APRIL J REED","gend":1,"add":"12120 LEE JACKSON HIGHWAY  ","city":"BIG ISLAND  ","state":"VA","zip":"24526-9998","dob":"1977-01-19","age":"","mstatus":"","insh":11018024,"cliId":"1JH2MR1ED17","pno":4344734925,"cno":4343163820,"email":"","ename":"","eno":"","pphy":"BOGACZ, KATHLEEN  ","ppno":5404633381,"pcpadd":"2321 Wards Rd","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245022101,"pcpcounty":"","pcpid":"P0159124","pcpname":"AUGUSTA MEDICAL GROUP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"12120 LEE JACKSON HIGHWAY  ","madd2":"","madd3":"","mcity":"BIG ISLAND  ","mstate":"VA","mzip":"24526-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z79.891","F11.20","F40.01","F43.12","F12.90","F11.21","F17.210"],"date":["2021-05-27","2021-11-17","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-05-19"],"priorHcc":["",null,null,null,null,null,null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","65862000899","METFORMIN ","TAB 500MG","360","Select","Select",""],["","12496120803","SUBOXONE ","8-2MG","42","Select","Select",""],["","74706890","SYNTHROID ","125MCG","90","Select","Select",""],["","68180063609","ATORVASTATIN","20MG","90","Select","Select",""],["","65862000899","METFORMIN","500MG","360","Select","Select",""],["","12496120803","SUBOXONE","8-2MG","39","Select","Select",""],["","00074706890","SYNTHROID","125MCG","90","Select","Select",""],["","68180063609","ATORVASTATIN ","TAB 20MG","90","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}