{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   NIMSAJSAMOHT R","gend":1,"add":" NAMPAHC 1251A TINU WS EVA","city":"ROANOKE","state":"VA","zip":"24016-9998","dob":"1991-11-16","age":"","mstatus":"","insh":"7031210*32","cliId":"","pno":"83\/0455497-9","cno":"","email":"","ename":"","eno":"","pphy":"AUSTIN, ANN ELIZABETH DO","ppno":"540\/224-5170","pcpadd":"3 RIVERSIDE CIRCLE","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24016,"pcpcounty":"","pcpid":"","pcpname":"Carilion Clinic Internal Medicine Riverside 3","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O34.219","Z37.0","Z3A.00","R73.02","N76.0","D35.2","Z71.3","Z01.818","E66.01","R73.03","E55.9","Z68.43","O99.513","O99.89","H66.002","J06.9","R09.81","J02.9","R05.","O99.213","E66.9","Z3A.31","H92.02","R53.83","M25.50","Z68.42","Z3A.13","Z86.018","O99.212","Z86.32","Z98.891","Z83.2","H66.42","Z71.89","D33.2","O34.211","Z3A.39","Z30.2","K12.2","R63.5","E63.9","Z86.2","Z87.19","R73.09","N93.9","G89.18","F12.90"],"date":["2019-07-31","2019-07-31","2019-07-31","2021-09-03","2021-03-09","2021-08-26","2021-09-20","2021-11-23","2021-12-28","2021-12-28","2021-11-30","2021-12-28","2019-06-01","2019-06-01","2019-06-01","2019-06-01","2019-06-01","2021-04-16","2019-06-01","2019-06-01","2019-06-01","2019-06-01","2019-06-01","2021-08-16","2021-08-16","2021-08-16","2019-01-30","2019-01-30","2019-01-30","2019-01-30","2019-01-30","2019-01-30","2019-06-01","2019-07-19","2021-12-28","2019-07-31","2019-07-31","2019-07-31","2021-06-25","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2019-08-05","2019-08-05","2021-11-23"],"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":{"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":[["","","OXYCOD\/APAP"," OXYCOD\/APAP ","10","Select","Select",""],["","","SERTRALINE"," SERTRALINE ","30","Select","Select",""],["","","AMOXICILLIN"," AMOXICILLIN ","14","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","90","Select","Select",""],["","","CABERGOLINE","TAB 0.5MG","","Select","Select",""],["","","PHENTERMINE","TAB 37.5MG","","Select","Select",""],["","","METFORMIN","TAB 500MG","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}