{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID FALLS","gend":0,"add":"359 THRASHER CREEK ROAD","city":"AMHERST","state":"VA","zip":"24521-9998","dob":"1964-08-25","age":"","mstatus":"","insh":"20082978*01","cliId":"","pno":4342383738,"cno":4342383738,"email":"","ename":"","eno":"","pphy":"HAYES, SHAWN MD","ppno":4342003908,"pcpadd":"125 NATIONWIDE DRIVE","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":"24502-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4342005948,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C61.","C79.51","E11.65","E87.6","Z01.812","H93.13","Z45.2"],"date":["2023-03-29","2023-02-01","2023-01-05","2022-12-02","2022-05-18","2022-10-28","2022-11-18"],"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":[["","70010049110","METFORMIN","TAB 500MG ER","60","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","43547040111","FUROSEMIDE","20 MG","270","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","40","Select","Select",""],["","53746054201","POT CHLORIDE","CAP 10MEQ ER","60","Select","Select",""],["","00168035730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","55111032001","GLIMEPIRIDE","1 MG","180","Select","Select",""],["","00310621030","FARXIGA","10 MG","90","Select","Select",""],["","42291002412","ABIRATERONE ACETATE","250 MG","120","Select","Select",""],["","70010049110","METFORMIN HCL ER","500 MG","180","Select","Select",""],["","00378064010","PREDNISONE","5 MG","30","Select","Select",""],["","53746054201","POTASSIUM CHLORIDE","10 MEQ","60","Select","Select",""],["","53746010901","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","40","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":""}]}]}