{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L TREBORRELLIM ","gend":0,"add":"REKAB42TEERTS ","city":"WINCHESTER","state":"VA","zip":"22601-4890","dob":"1962-08-09","age":"","mstatus":"","insh":"02013436","cliId":"","pno":"7804575077","cno":"","email":"","ename":"","eno":"","pphy":"KEILMAN, DAVID A","ppno":5407253060,"pcpadd":"5303 INDIAN GRAVE RD,","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":"24018-9107","pcpcounty":"","pcpid":"","pcpname":"LEWIS GALE PHYSICIANS LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"24BAKER STREET","add3":"","madd1":"24BAKER STREET","madd2":"","madd3":"","mcity":"WINCHESTER","mstate":"VA","mzip":"22601-4890","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H27.02","H43.02","H53.8","H35.371","H35.363","J45.909","E78.5","I10","H91.90","F17.210","G40.909","Z86.19","Z01.818","J44.9","Z53.9","Z28.3","L98.9","A63.0","Z71.6","L28.2","E78.2","R06.09","J04.0","M79.604","T14.8XXA","H61.23","H91.91","H61.22","R03.0","Z13.29","Z12.5","Z13.1","H90.3","J34.89","H93.299","J32.9","H90.A21","G93.89","S00.03XA","H90.5","I67.82","J32.0","J32.2","J32.1","J34.2","S06.0X0A","F10.920","F10.120","R07.9","R25.1","R06.02","Z74.3","F17.200","M31.30","F10.230","R11.2","F10.239","K76.9","E80.6","F10.231","Y90.0","R17","D69.6","E66.3","Z68.26","E87.6","K29.70","E83.42","Z59.00","D75.89","E87.5","M62.81","E87.2","N17.9","R69","Z53.21","S09.90XA","F10.929","T51.91XA","Z20.822","R53.1","R41.82","M25.551","S70.01XA","W22.8XXA","M48.07","M43.17","M47.816","M79.609","S76.019A","D53.9","R74.8","F10.939","T79.6XXA","M79.18","M54.16","M54.2","R29.6","S31.809A","S30.0XXA","R10.2","W18.30XA","G93.41","D61.818","R34","E86.0","T39.1X6A","M48.061","F10.931","M62.82","F10.220","J18.9","I49.9","M54.50","R51.9","R19.7","R10.9","R07.81","R68.83","F10.10","R91.8","T50.991A","D17.0","R20.2","R00.0","F10.129","S02.2XXA","M54.9","R05.9","R06.2","Y04.2XXA","Z04.3","N28.1","R91.1","Y09","Y04.0XXA","Y90.8","Y92.9","E87.1","E51.9","B19.20","F10.921","F10.20","Z91.199","M79.605","F32.A","Z79.899","F32.9","R07.89","R40.0","T42.4X5A"],"date":["2021-01-20","2021-01-20","2021-01-11","2021-01-11","2021-01-11","2023-01-28","2023-03-22","2023-03-22","2022-08-22","2022-08-22","2022-06-28","2021-01-20","2021-01-23","2023-02-01","2021-02-22","2021-02-22","2021-02-22","2021-10-07","2021-04-28","2021-06-11","2021-06-21","2021-06-21","2021-06-21","2023-02-03","2022-08-20","2021-08-19","2021-10-07","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-11-24","2021-11-24","2021-10-28","2021-10-28","2021-10-28","2021-12-02","2021-11-24","2021-11-24","2021-11-24","2021-12-02","2021-12-02","2021-12-02","2021-12-02","2021-12-16","2023-03-23","2023-03-22","2022-08-04","2022-12-22","2023-03-23","2023-03-23","2022-03-21","2022-03-21","2022-06-29","2022-06-25","2023-02-01","2022-06-27","2022-06-27","2023-01-28","2022-06-26","2022-06-26","2022-06-26","2022-06-26","2022-06-26","2023-01-28","2022-06-26","2023-01-28","2023-01-28","2022-06-26","2022-08-03","2022-06-29","2022-07-01","2022-07-01","2022-07-28","2022-07-28","2022-08-09","2023-03-23","2022-08-03","2023-03-22","2023-01-25","2022-08-04","2022-08-16","2022-08-16","2022-08-16","2022-08-18","2022-08-18","2022-08-18","2022-08-18","2022-08-18","2022-08-22","2022-08-20","2023-01-26","2022-08-22","2022-08-18","2022-08-20","2022-08-20","2022-08-20","2022-08-22","2022-08-22","2022-08-22","2022-08-22","2022-08-24","2022-08-22","2022-08-22","2022-08-22","2022-08-22","2022-08-22","2023-01-31","2022-08-24","2023-01-28","2022-09-24","2022-09-24","2022-09-24","2022-12-22","2022-09-24","2022-09-24","2022-09-24","2022-09-24","2022-09-24","2023-02-01","2022-09-24","2022-12-22","2022-12-22","2022-12-22","2023-01-26","2023-02-01","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2023-01-26","2023-01-28","2023-01-28","2023-01-28","2023-01-28","2023-02-01","2023-01-28","2023-01-31","2023-01-30","2023-01-31","2023-02-03","2023-03-22","2023-03-22","2023-03-23","2023-03-23","2023-03-23","2023-03-23"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":[]},{"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":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}