{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACOB   T POTEAT","gend":0,"add":"809   MICA ROAD                                             ","city":"RIDGEWAY                      ","state":"VA","zip":"24148-3498","dob":"2002-07-02","age":"","mstatus":"","insh":6879186,"cliId":"","pno":2762245305,"cno":"","email":"","ename":"","eno":"","pphy":"EGGLESTON-CLARK, VALENICA R                                 ","ppno":5404637628,"pcpadd":"1107 Brookdale St                                           ,                                                            ","pcpcity":"Martinsville                  ","pcpstate":"VA","pcpzip":241124501,"pcpcounty":"","pcpid":"","pcpname":"CARILION MEDICAL ASSOCIATES MARTINSVILLE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"809   MICA ROAD                                             ","add3":"","madd1":"809   MICA ROAD                                             ","madd2":"                                                            ","madd3":"","mcity":"RIDGEWAY                      ","mstate":"VA","mzip":"24148-3498","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J02.9","R68.89","R51","R56.9","Z79.899","Z86.59","R00.0","R07.9","F41.9","F31.9","F32.9","Z88.0","F43.22","Z11.52","Z87.898","M25.561","M79.642","Y04.0XXD","F12.90","M25.461","G45.9","R52","R45.7","M79.603","R51.9","K13.79","R20.0","Z86.73","G40.909","F17.200","R93.0","F31.32","F39","G44.209","F41.1","M62.838","R55","F43.25","G47.9","Z20.822","S05.02XA","J01.90","R50.9"],"date":["2022-11-03","2020-01-07","2020-03-05","2021-09-30","2021-09-30","2021-09-22","2021-08-26","2021-08-26","2021-09-26","2021-08-26","2021-09-22","2021-08-26","2021-09-20","2021-09-16","2021-09-22","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-09-26","2021-09-26","2021-09-26","2021-09-26","2021-09-26","2021-09-26","2021-09-30","2021-09-26","2021-10-26","2021-09-26","2021-09-26","2022-03-08","2021-11-23","2021-10-11","2021-10-26","2021-10-11","2021-10-26","2021-11-23","2021-11-23","2022-09-01","2022-02-01","2022-11-03","2022-11-03"],"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":[]},{"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":[["","00093816201","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","55111053401","DIVALPROEX","TAB 500MG ER","30","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","60505056000","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","14539067401","HYDROXYZ","CAP 25MG","15","Select","Select",""],["","45802057178","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","60505025103","TIZANIDINE","TAB 2MG","20","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":""}]}]}