{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  NITSIRKNWORB P ","gend":1,"add":"        DAOR YRUBRETNAC   1191                              ","city":"ROANOKE                       ","state":"VA","zip":"24015-3017","dob":"1987-07-11","age":"","mstatus":"","insh":"91011999","cliId":"","pno":"2504526755","cno":5405255762,"email":"","ename":"","eno":"","pphy":"ARTHUR, CHRISTY L                                           ","ppno":"","pcpadd":"3707 Brambleton Ave Ste 2","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240183658,"pcpcounty":"","pcpid":"P0117359","pcpname":"CARILION FAMILY MEDICINE BRAMBLETON","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1911   CANTERBURY ROAD                                      ","madd2":"                                                            ","madd3":"","mcity":"ROANOKE                       ","mstate":"VA","mzip":"24015-3017","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z79.891","F90.9","R10.2","R10.30","R19.7","R11.0","R10.31","R93.3","Z79.899","Z51.81","R07.81","S22.31XA","V86.59XA","V29.9XXA","S22.41XD","M62.838","V86.55XA","R05","R50.9","R68.83","J02.9","R53.83","Z20.822","F98.8","G47.00"],"date":["2021-08-10","2020-10-21","2020-03-16","2020-03-16","2020-03-16","2020-03-16","2020-03-16","2020-03-16","2020-03-30","2021-03-04","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-04","2020-08-04","2020-08-04","2021-01-04","2020-08-26","2020-08-26","2021-01-04","2021-01-04","2021-01-04","2021-08-10","2021-08-10"],"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":[["","69097084507","CYCLOBENZAPR","5MG","30","Select","Select",""],["","53746011001","HYDROCO\/APAP","10-325MG","30","Select","Select",""],["","50111056003","TRAZODONE","50MG","30","Select","Select",""],["","00143312601","DICYCLOMINE","10MG","15","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","58657050016","CODEINE\/GG","10-100\/5","120","Select","Select",""],["","45802005535","TRIAMCINOLON","0.10%","30","Select","Select",""],["","69097084507","CYCLOBENZAPR ","TAB 5MG","30","Select","Select",""],["","53746011001","HYDROCO\/APAP ","TAB 10-325MG","30","Select","Select",""],["","50111056003","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","00143312601","DICYCLOMINE ","CAP 10MG","15","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","58657050016","CODEINE\/GG ","SOL 10-100\/5","120","Select","Select",""],["","45802005535","TRIAMCINOLON ","OIN 0.001","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","",""],["N\/A","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":""}]}]}