{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAYLA HONEYCUTT","gend":1,"add":"8130 SOUTH RIVER RD  ","city":"POUND ","state":"VA","zip":"24279-9998","dob":"1994-01-03","age":"","mstatus":"","insh":11018382,"cliId":"1MH7HX3YC46","pno":2762206871,"cno":2763286293,"email":"","ename":"","eno":"","pphy":"DEEL, SAMUEL P ","ppno":2766799100,"pcpadd":"310 3rd St NE","pcpcity":"Norton","pcpstate":"VA","pcpzip":242731137,"pcpcounty":"","pcpid":"P9059240","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"P0 BOX 4083 ","madd2":"","madd3":"","mcity":"WISE  ","mstate":"VA","mzip":"24293-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z79.899","F11.20","E66.01","E11.69","F32.9","I10","Q87.40","F11.21","G47.10","G47.33","G47.8","E28.2","Z01.419","N92.5","B37.3","R10.2","R87.610"],"date":["2021-08-05","2021-09-30","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-10-06","2021-10-07","2021-10-07","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28"],"priorHcc":["","","","","","","","","","","","","","","","",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":[["","47781035703","BUPREN\/NALOX","8-2MG","56","Select","Select",""],["","16729030116","TRAZODONE","150MG","60","Select","Select",""],["","00088222033","LANTUS","100\/ML","30","Select","Select",""],["","47781064390","LEVOTHYROXIN","50MCG","30","Select","Select",""],["","49483060601","GABAPENTIN","300MG","90","Select","Select",""],["","12496120803","SUBOXONE","8-2MG","56","Select","Select",""],["","00088222033","LANTUS ","INJ 100\/ML","30","Select","Select",""],["","47781064390","LEVOTHYROXIN ","TAB 50MCG","30","Select","Select",""],["","23155010410","METFORMIN ","TAB 1000MG","180","Select","Select",""],["","86227080105","INSULIN ","MIS 1ML\/28G","100","Select","Select",""],["","47781035703","BUPREN\/NALOX ","MIS 8-2MG","70","Select","Select",""],["","57599080300","FREESTY ","MIS 2 READER","1","Select","Select",""],["","16729030116","TRAZODONE ","TAB 150MG","60","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","68462010340","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","49483060650","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","59762374202","MEDROXYPR ","TAB 10MG","10","Select","Select",""],["","00781542092","PIOGLITAZONE ","TAB 15MG","30","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","56","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":"","a12":""}]}]}