{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AYNOTTRAHED","gend":1,"add":"               LLAH EISUS                         ","city":"SALEM                    ","state":"VA","zip":"24153-8112","dob":"1971-09-17","age":"","mstatus":"","insh":"00112164","cliId":"","pno":"8304525730","cno":"","email":"","ename":"","eno":"","pphy":"WHITING, JESSICA RENEE","ppno":5405919456,"pcpadd":"1818 ELECTRIC RD,","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240181619,"pcpcounty":"","pcpid":"","pcpname":"CARILION CLINIC PRIMARY CARE ASSOCIATES ELECTRIC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"2747   BEAVER BROOK ROAD                          ","add3":"","madd1":"SUSIE HALL                                        ","madd2":"2747   BEAVER BROOK ROAD                          ","madd3":"","mcity":"SALEM                    ","mstate":"VA","mzip":"24153-8112","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G35","E78.5","E55.9","Z00.00","Z12.31","Z12.11","Z71.89","F32.9","G37.9","G37.8","Z79.899","R26.81","R26.2","M62.81","G31.84","Z23","R90.82","M26.643","F02.81","F33.1","H47.293","H55.00","H40.011","F31.9","Z82.3","Z82.49","Z83.3","Z87.891","H53.9","R25.1","Z20.818","Z68.21","Z86.61","F02.80","R90.89","H52.4","I10","Z68.22","F32.A"," "],"date":["2022-07-19","2022-07-18","2022-07-18","2022-01-11","2022-03-16","2022-01-11","2022-07-18","2020-03-06","2020-12-08","2020-04-21","2020-12-08","2019-04-30","2019-05-21","2019-05-21","2020-12-28","2021-08-02","2021-09-05","2021-09-05","2018-11-14","2020-12-28","2019-09-19","2019-09-19","2019-09-19","2021-11-20","2019-10-02","2019-10-02","2019-10-02","2020-12-28","2018-10-11","2018-10-11","2018-10-11","2018-10-11","2018-10-11","2019-12-10","2018-12-19","2020-12-28","2020-12-28","2020-12-28","2022-07-18","2022-07-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","16714061304","SERTRALINE","TAB 100MG","30","Select","Select",""],["","16714087501","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","00078060715","GILENYA","CAP 0.5MG","30","Select","Select",""],["","42291065712","OMEGA-3-ACID","CAP 1GM","120","Select","Select",""],["","49281072110","FLUBLOK","INJ 2021-22","0.5","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0.5","Select","Select",""],["","57237004101","PENICILLN","TAB 500MG","21","Select","Select",""],["","68382009810","PAROXETINE","TAB 20MG","90","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":""}]}]}