{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTANY   D COUTS","gend":1,"add":"1501 WYNDHAM DRIVE","city":"VINTON                        ","state":"VA","zip":"24179-3549","dob":"1992-01-08","age":"","mstatus":"","insh":6813083,"cliId":"","pno":5409706853,"cno":4439791213,"email":"","ename":"","eno":"","pphy":"BEACH, BRIANA MARY","ppno":5405625700,"pcpadd":"1906 Belleview Ave SE,","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240141838,"pcpcounty":"","pcpid":"","pcpname":"CARILION CLINIC FAMILY MEDICINE SOUTHEAST","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"1501 WYNDHAM DRIVE","add3":"","madd1":"1501 WYNDHAM DRIVE","madd2":"APT H","madd3":"","mcity":"VINTON                        ","mstate":"VA","mzip":"24179-3549","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","R51","G43.A0","R11.2","Z87.891","F31.60","F41.1","F11.20","J02.9","Z20.828","E86.0","D72.829","I49.9","J40","R05","G40.909","R52","R50.9","A60.00","R56.9","M79.604","M79.605","M79.89","F33.1","S02.2XXA","K02.9","R51.9","R04.0","W20.8XXA","Y93.I1","F17.200","S00.31XA","Z20.822","R60.0","R73.9","F17.210"],"date":["2020-04-10","2020-08-16","2020-05-08","2020-07-27","2020-08-16","2020-06-15","2021-06-01","2020-06-21","2020-07-01","2021-08-21","2020-08-16","2020-08-16","2020-12-15","2020-08-16","2020-08-16","2020-08-16","2020-08-16","2020-08-16","2020-12-10","2020-12-15","2021-05-19","2021-05-19","2021-09-20","2021-06-01","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-08-04","2021-09-30","2021-09-30","2021-09-30"],"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":[["","70954001910","PRAZOSIN","CAP 1MG","30","Select","Select",""],["","14539067501","HYDROXYZ","CAP 50MG","120","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","13107015490","PAROXETINE","TAB 10MG","30","Select","Select",""],["","16729020001","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","60","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","30","Select","Select",""],["","67877026218","RIZATRIPTAN","TAB 10MG","6","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","6","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","12","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","23155022801","ACYCLOVIR","TAB 800MG","50","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":""}]}]}