{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JONATHON R GRIGGS","gend":0,"add":"PO BOX 320","city":"PEMBROKE","state":"VA","zip":241360320,"dob":"1991-10-20","age":"","mstatus":"","insh":11002013,"cliId":"4MA3KN8VM70","pno":5405990249,"cno":5409212506,"email":"","ename":"","eno":"","pphy":"DEVEREAUX, ROBERT","ppno":5409213636,"pcpadd":"430 Boxwood Ln","pcpcity":"Pearisburg","pcpstate":"VA","pcpzip":241341168,"pcpcounty":"","pcpid":"P9058429","pcpname":"CARILION CLINIC FAMILY MEDICINE GILES RURAL HEALTH","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"ROANOKE\/ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","Z23","M25.511","M25.571","G89.29","M25.572","M25.611","M62.81","M25.671","M25.672","M79.89","L91.8","M25.674","M25.675","M79.672","M79.671","M21.42","M21.41","M21.40","J45.20","Z00.00","J30.2","E66.9","A69.20","J02.9","R21","R50.9","K21.9","G51.0","R29.810","W57.XXXS","H30.142","J06.9","F95.1","G47.00","B97.89","J01.90","F43.21","I11.9","I51.7","R59.0"],"date":["2021-01-26","2020-12-15","2019-03-04","2019-04-01","2019-04-01","2019-04-01","2019-02-04","2019-03-04","2019-03-04","2019-03-04","2019-04-01","2019-04-08","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-04-18","2019-04-18","2019-06-05","2020-12-15","2020-06-03","2020-12-15","2020-12-15","2018-07-25","2018-06-14","2018-06-15","2018-06-14","2018-06-14","2019-06-20","2018-06-15","2018-06-18","2019-06-20","2018-10-02","2018-10-02","2018-10-02","2018-10-02","2019-11-19","2018-12-03","2021-01-13","2021-01-13","2020-12-29"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}