{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M ASERETAREDAM ","gend":1,"add":"SWEM 8784RD LLIH ","city":"ROANOKE","state":"VA","zip":"24018-9998","dob":"1978-12-12","age":"","mstatus":"","insh":"00112853","cliId":"","pno":"8604546352","cno":"5407592388","email":"","ename":"","eno":"","pphy":"SWEET, MARY G","ppno":"5405625700          ","pcpadd":"1314 Peters Creek Rd Nw Ste 14, ","pcpcity":"1314 Peters Creek Rd Nw Ste 14,","pcpstate":"VA","pcpzip":"240172500","pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY MEDICINE ROANOKE SALEM","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"4878 MEWS HILL DR","madd2":"","madd3":"","mcity":"ROANOKE","mstate":"VA","mzip":"24018-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","Z51.81","Z79.899","R41.82","Z74.3","F15.20","I69.351","I69.320","I69.390","I69.398","R25.2","F11.23","F17.210","Z86.73","I69.341","Z68.25","R52","M79.2","F11.90","F15.90","Z90.49","R10.9","R07.9","F11.10","R06.02","K29.70","R11.10","N20.0","R10.30","R10.31","R10.32","R22.31","N39.0","R19.7","F17.200","M79.89","M79.644","W49.04XA","G40.909","Z11.1","F19.90","Z91.89","Z78.9"],"date":["2022-03-17","2022-03-09","2022-03-09","2020-08-05","2021-09-08","2021-08-25","2020-10-12","2020-10-12","2020-10-12","2018-12-14","2020-10-12","2018-12-11","2021-09-08","2021-09-08","2020-01-14","2020-01-14","2021-09-08","2020-10-12","2020-10-14","2020-10-14","2020-10-14","2019-01-28","2019-12-26","2020-10-14","2019-12-26","2018-12-27","2018-12-27","2019-01-28","2019-01-28","2019-01-28","2019-01-28","2021-09-08","2019-01-28","2019-01-28","2019-01-28","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2018-12-11","2018-12-11","2018-12-11","2018-12-11"],"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":[["","12496120803","SUBOXONE","MIS 8-2MG","14.00","Select","Select",""],["","59746017710","CYCLOBENZAPR","TAB 10MG","90.00","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14.00","Select","Select",""],["","69547035302","NARCAN","SPR ","2.00","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","180.00","Select","Select",""],["","00054018913","BUPREN\/NALOX","SUB 8-2MG","14.00","Select","Select",""],["","33332042010","AFLURIA","INJ 2020-21","0.50","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":""}]}]}