{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" REGORSKWAH","gend":0,"add":"  DAOR ENILYTNUOC   60411                         ","city":"COPPER HILL              ","state":"VA","zip":"24079-1738","dob":"1955-10-09","age":"","mstatus":"","insh":"10118055","cliId":"","pno":"3304501329","cno":"","email":"","ename":"","eno":"","pphy":"MERTEN, JOHN R","ppno":5405625700,"pcpadd":"1314 PETERS CREEK ROAD,","pcpcity":"ROANOKE","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":"11406   COUNTYLINE ROAD                           ","madd2":"                                                  ","madd3":"","mcity":"COPPER HILL              ","mstate":"VA","mzip":"24079-1738","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H90.3","H61.21","H60.399","Z68.1","Z72.0","J44.1","F10.129","F10.20","C20","R91.8","C19","H61.20","R07.89","F10.220","F17.210","Z85.038","K21.9","J02.9","I25.10","I70.0","Z98.890","F10.10","R06.02","K22.89","R13.10","C13.9","K22.9","R07.0","J44.9","Z85.048","Z79.899","Z01.818","Z51.0","C12","Z92.21","Z92.3","Z80.52","C13.0","H90.71","F32.A","F41.9","Z90.49","C76.0","G93.0","M54.2","I65.22","H90.A31","H90.A22","Z20.822","B37.9","C15.9","F10.99","Z08"," ","C14.0","Z85.818"],"date":["2022-04-29","2022-04-29","2021-05-21","2021-06-03","2021-06-03","2021-06-21","2021-06-21","2021-06-21","2022-03-04","2022-03-04","2022-03-31","2021-06-03","2021-06-21","2021-06-21","2022-09-15","2022-05-12","2021-06-21","2021-11-26","2021-03-03","2021-03-03","2021-03-03","2021-06-21","2021-06-21","2022-05-08","2022-05-08","2022-05-12","2022-05-12","2022-05-08","2022-05-12","2022-05-26","2022-05-08","2022-05-09","2022-11-22","2022-09-15","2022-11-22","2022-11-22","2022-05-26","2022-11-16","2022-05-12","2022-05-12","2022-05-12","2022-05-12","2022-05-08","2022-05-08","2022-05-08","2022-05-08","2022-04-29","2022-04-29","2022-05-09","2022-05-12","2022-05-08","2022-08-12","2022-11-22","2022-11-22","2022-11-22","2022-11-22"],"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":[]}},{"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":""}]}]}