{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"N   AHSELAYELBMUHC ","gend":1,"add":"         EUNEVA ATSUGUA E  343                              ","city":"VINTON                        ","state":"VA","zip":"24179-3410","dob":"1997-05-11","age":"","mstatus":"","insh":"50017794","cliId":"","pno":"4932409213","cno":4239431290,"email":"","ename":"","eno":"","pphy":"TRUXILLO, RICHARD                                           ","ppno":"","pcpadd":"2145 Mount Pleasant Blvd SE,Ste 1","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240143632,"pcpcounty":"","pcpid":"P0117344","pcpname":"CARILION FAMILY MEDICINE ROANOKE SALEM","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT 2                                                       ","add3":"","madd1":"343  E AUGUSTA AVENUE                                       ","madd2":"APT 2                                                       ","madd3":"","mcity":"VINTON                        ","mstate":"VA","mzip":"24179-3410","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.81","F33.1","J45.20","Z23","R53.83","F31.32","F90.2","F31.4","J45.901","N39.0","F17.210","Z88.0","R30.0","Z32.01"],"date":["2019-02-25","2019-01-03","2019-02-14","2019-01-10","2019-01-10","2019-01-22","2019-01-22","2019-01-28","2019-02-04","2019-04-16","2019-04-16","2019-04-16","2019-04-16","2020-06-29"],"priorHcc":["","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00536408501","PRENATAL","28-0.8MG","30","Select","Select",""],["","00536408501","PRENATAL ","TAB 28-0.8MG","30","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}