{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REBECCA   S FREITAS","gend":1,"add":"221 ANDERSON STREET                                         ","city":"ROCKY MOUNT                   ","state":"VA","zip":"24151-1279","dob":"1990-11-24","age":"","mstatus":"","insh":4683530,"cliId":"","pno":5402430967,"cno":"","email":"","ename":"","eno":"","pphy":"FRANKO, JAMES B                                             ","ppno":"","pcpadd":"3 Riverside Cir,","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240164955,"pcpcounty":"","pcpid":"","pcpname":"CARILION FRANKLIN MEMORIAL HOSPITAL HOSPITALISTS","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"221 ANDERSON STREET","madd2":"                                                            ","madd3":"","mcity":"ROCKY MOUNT                   ","mstate":"VA","mzip":"24151-1279","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.644","S69.81XA","S69.91XA","W22.8XXA","Y93.9","Y92.9","F17.210","Z01.419","Z12.31","Z30.41","Z00.00","T40.1X1A","E87.6","R00.0","R94.31","R41.82","F17.200","S02.5XXA","Z72.0","Z12.39","Z12.4","Z11.51","F43.21","Z86.59","O20.9","O99.331","Z3A.01"],"date":["2019-03-20","2019-03-20","2019-03-20","2019-03-20","2019-03-20","2019-11-20","2019-03-20","2020-11-05","2019-09-10","2019-09-10","2019-10-07","2019-11-20","2019-11-20","2019-11-20","2019-11-20","2019-11-20","2021-05-31","2020-04-30","2020-11-05","2020-11-05","2020-11-05","2020-11-05","2021-01-04","2021-01-04","2021-05-31","2021-05-31","2021-05-31"],"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":[["","00378334053","XULANE","DIS 150-35","9","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","00536589488","NICOTINE","DIS 7MG\/24HR","14","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","20","Select","Select",""],["","61442011401","ACYCLOVIR","CAP 200MG","40","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":""}]}]}