{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID   B DEBOE","gend":0,"add":"660 SLAYTON ROAD","city":"SUTHERLIN","state":"VA","zip":"24594-9998","dob":"1959-12-19","age":"","mstatus":"","insh":"900044586*01","cliId":"","pno":"434\/203-9169","cno":"","email":"","ename":"","eno":"","pphy":"STEPHENS, AMBER L DO","ppno":"434\/799-4488","pcpadd":"SUITE 201 109 BRIDGE STREET","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"DANVILLE PHYSICIAN PRACTICES LLC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/773-6977","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C61.","C32.1","R53.83","E89.0","E11.9","I65.23","G47.33","I48.20","I10.","C80.1","M54.16","M12.9","E78.5","R06.09","Z13.6","I73.9","J43.2","I51.7","Z92.3","Z87.891","I48.19","I65.21","M54.5","R09.02","M54.30"],"date":["2021-02-01","2021-10-25","2021-04-21","2021-10-25","2021-07-26","2021-09-09","2021-12-18","2021-11-02","2021-11-02","2021-03-09","2021-03-09","2021-03-09","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-06-22","2021-01-29","2021-02-01","2021-02-01","2021-07-26","2021-02-09","2021-09-09","2021-09-09","2021-09-09"],"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":[]}]},{"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":[["","68382009505","CARVEDILOL                                                            ","25MG","-60","Select","Select",""],["","00173088210","BREO ELLIPTA                                                          ","200-25","-60","Select","Select",""],["","31722070190","LOSARTAN POTASSIUM                                                    ","50MG","30","Select","Select",""],["","00597010061","SPIRIVA RESPIMAT                                                      ","2.5MCG","12","Select","Select",""],["","00093505898","ATORVASTATIN CALCIUM                                                  ","40MG","90","Select","Select",""],["","62037059890","CARTIA XT                                                             ","180\/24HR","90","Select","Select",""],["","00003089421","ELIQUIS                                                               ","5MG","60","Select","Select",""],["","68382005105","MELOXICAM                                                             ","15MG","90","Select","Select",""],["","47781064390","LEVOTHYROXINE SODIUM                                                  ","50MCG","30","Select","Select",""],["","67877041301","METFORMIN HYDROCHLORIDE ER                                            ","500MG ER","90","Select","Select",""],["","72305005030","EUTHYROX                                                              ","50MCG","-30","Select","Select",""],["","24979002702","DILTIAZEM HYDROCHLORIDE ER                                            ","180MG ER","90","Select","Select",""],["","49281042150","FLUZONE QUADRIVALENT 2021-2022                                        ","2021-22","0","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}