{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A   RIMAHESBABA ","gend":0,"add":"IREPSIHW 9295DAOR ENIP GN","city":"CASCADE","state":"VA","zip":"24069-9998","dob":"2004-08-13","age":"","mstatus":"","insh":"8435110*91","cliId":"","pno":"24\/4349850-1","cno":"","email":"","ename":"","eno":"","pphy":"LEONG, APOLLO Y MD","ppno":"540\/772-8950","pcpadd":"1818 ELECTRIC RD","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24018,"pcpcounty":"","pcpid":"","pcpname":"CARILION HEALTHCARE CORPORATION","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J02.9","J30.2","V58.89","M54.2","R20.2","X58.XXXD","S06.0X0A","S63.615A","M79.642","G54.0","M25.512","M22.8X2","S13.4XXA","R42.","M54.6","J32.9","R51.9","R05.","R09.81","J45.909","J06.9","S63.92XA","W18.39XA","S89.92XA","S80.02XA","M79.601","Z79.899","M25.862","Q66.51","Q66.52","R06.02","Z79.1","T23.291A","M25.511","M75.41","S83.204A","W19.XXXA","X58.XXXA","S06.9X0A","G47.9","Z87.820","R51.","J34.89","M25.562","G89.29","S06.0X9A","R52."],"date":["2020-01-13","2019-05-11","2020-12-14","2020-02-05","2019-10-24","2019-10-24","2020-11-16","2019-06-24","2019-06-24","2020-07-15","2020-06-04","2020-06-15","2019-10-03","2020-11-30","2020-07-15","2021-04-18","2021-04-18","2021-04-18","2021-04-18","2021-04-18","2021-08-16","2019-06-15","2019-06-15","2019-09-06","2019-09-27","2020-02-05","2021-04-18","2020-08-11","2020-08-11","2020-08-11","2021-04-18","2021-04-18","2021-11-25","2020-03-12","2020-03-19","2020-06-05","2020-06-05","2020-11-11","2020-11-30","2020-11-30","2020-03-12","2019-11-11","2020-02-20","2020-06-09","2020-06-09","2020-11-11","2019-10-03"],"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":[["","66685100100","AMOX\/K","TAB 875-125","20","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","30","Select","Select",""],["","","BACLOFEN","TAB 10MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","","CEFDINIR","CAP 300MG","","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":""}]}]}