{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CINOREVNAMOR A","gend":1,"add":"2 C747TS HT9","city":"ROANOKE","state":"VA","zip":"24017-9998","dob":"1979-12-03","age":"","mstatus":"","insh":"75400210*12","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"BRACKENRICH, WAYNE L DO","ppno":"540\/265-5500","pcpadd":"6415 PETERS CREEK ROAD","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24019,"pcpcounty":"","pcpid":"","pcpname":"Carilion Family Medicine North Roanoke","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["R55.","F33.9","F41.9","F41.8","F33.2","R73.03","J20.8","E03.9","B96.89","C50.211","Z17.0","R11.2","R19.7","R10.13","Z20.822","N39.0","E86.0","S33.5XXA","Z98.84","E56.9","Z86.2","E55.9","F32.9","J06.9","J01.40","G47.33","F32.2","F43.21","K21.9","E66.9","Z68.39","F41.0","F32.1","R46.2"],"date":["2020-03-08","2021-01-27","2021-01-27","2020-05-18","2020-11-16","2020-05-18","2020-05-18","2020-06-19","2020-05-18","2021-07-15","2021-07-15","2021-02-11","2020-03-08","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-05-13","2020-06-19","2020-06-19","2020-06-19","2020-06-19","2020-11-10","2020-01-08","2020-01-08","2019-03-29","2019-04-25","2019-05-30","2019-06-14","2019-05-10","2019-05-10","2019-03-22","2019-03-22","2019-06-05"],"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":[]}},{"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":""}]}]}