{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICIA   M CLAYTOR","gend":1,"add":"721 AUGUSTA AVE B12","city":"GROTTOES","state":"VA","zip":"24441-9998","dob":"1952-10-04","pno":"540\/908-1713","cno":"540\/908-1713","email":"","pphy":"CAVENDER, MICHAEAL T DO","ppno":"","pcpadd":"1371 LEE HIGHWAY","pcpcity":"VERONA","pcpstate":"VA","pcpzip":24482,"pcpcounty":"","pcpid":147705,"pcpname":"Carilion Family Medicine Fort Defiance","insh":"900042765*01","cliId":"1JN8H02YE42","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/248-8413","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.2","I10.","Z12.11","G60.9","F51.04","F41.9","M54.5","F32.9","Z00.00"],"date":["2021-09-27","2021-09-27","2021-05-23","2021-09-27","2021-09-27","2021-09-27","2021-03-04","2021-09-27","2021-09-27"],"priorHcc":[null,null,null,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":[["","31722070190","LOSARTAN","50MG","90","Select","Select",""],["","16729004517","ATORVASTATIN","20MG","90","Select","Select",""],["","00093005101","CARVEDILOL","3.125MG","180","Select","Select",""],["","16714033002","GABAPENTIN","600MG","270","Select","Select",""],["","68382080605","TRAZODONE","100MG","90","Select","Select",""],["","68382003616","VENLAFAXINE","150MG ER","90","Select","Select",""],["","43547027603","DONEPEZIL","10MG","90","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","68382080605","TRAZODONE ","TAB 100MG","90","Select","Select",""],["","62175089143","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","31722070190","LOSARTAN ","TAB 50MG","-30","Select","Select",""],["","68382003616","VENLAFAXINE ","CAP 150MG ER","90","Select","Select",""],["","16714033002","GABAPENTIN ","TAB 600MG","270","Select","Select",""],["","00093005101","CARVEDILOL ","TAB 3.125MG","180","Select","Select",""],["","43547027603","DONEPEZIL ","TAB 10MG","90","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0","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","",""],["Yes","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":"","a12":""}]}]}