{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"C AILUJYENTRAO","gend":1,"add":"AO ETIHW 9021DAOR EVORG K","city":"RINER","state":"VA","zip":"24149-3641","dob":"1965-02-05","age":"","mstatus":"","insh":"91015889","cliId":"","pno":"4404552739","cno":"","email":"","ename":"","eno":"","pphy":"HULLETT, JOEL","ppno":5407455700,"pcpadd":"249 FRANKLIN PIKE SE,","pcpcity":"Floyd","pcpstate":"VA","pcpzip":"24091-2893","pcpcounty":"","pcpid":"","pcpname":"CARILION CLINIC PRIMARY CARE ASSOCIATES FLOYD","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"1209 WHITE OAK GROVE ROAD","add3":"","madd1":"1209 WHITE OAK GROVE ROAD","madd2":"","madd3":"","mcity":"RINER","mstate":"VA","mzip":"24149-3641","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z43.3","Z43.2","R53.1","F43.23","C20","G89.3","K22.0","D50.9","D22.9","Z85.820","L82.1","Z12.83","K76.89","N28.89","K44.9","K80.20","N20.0","Z92.21","Z92.3","C43.62","N93.9","Z93.3","F06.4","Z01.818","D12.0","D21.0","Z85.048","Z90.49","Z12.11","Z85.038","Z93.2","K21.9","F41.9","F32.9","E66.9","Z68.27","Z91.89","Z87.891","Z79.899","K22.89","R59.0","K21.00","R92.1","J98.11","I70.0","I25.10","N90.89","Z11.1","I80.01","I80.9","M79.604","Z86.718","M79.89","Z12.31","Z12.39","M54.9","R30.0","R68.83","R11.0","N15.9","R18.8"],"date":["2023-05-06","2023-05-06","2023-05-06","2022-09-23","2023-05-06","2021-03-08","2022-03-18","2021-03-16","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-05-27","2021-05-27","2022-05-20","2022-05-20","2022-05-20","2021-05-27","2021-05-27","2021-05-27","2021-06-10","2023-01-23","2021-06-10","2021-08-22","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-10-29","2022-05-20","2022-03-18","2022-05-20","2022-05-20","2022-05-20","2022-05-20","2022-07-21","2022-08-04","2022-08-13","2022-08-13","2022-08-13","2022-08-13","2022-08-13","2022-09-01","2022-09-01","2023-04-06","2023-04-06","2023-04-06","2023-04-06","2023-04-06","2023-05-10"],"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":{"comment":"","sub":[["","13668042905","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","43547028211","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","00904759180","FERROUS SULF","TAB 325MG","30","Select","Select",""],["","00904759060","FEROSUL","TAB 325MG","30","Select","Select",""],["","16729044316","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","80777027398","MODERNA VAC","INJ COVID-19","0.25","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","00003376474","ELIQUIS ST P","TAB 5MG","74","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":["",""],"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":""}]}]}