{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YETTA S JONES","gend":1,"add":"1449 W FAYETTE ST","city":"MARTINSVILLE","state":"VA","zip":241129999,"dob":"1937-04-07","age":"","mstatus":"","insh":11008470,"cliId":"5CR0WN1NR25","pno":2766323965,"cno":"","email":"","ename":"","eno":"","pphy":"STAMBAUGH, MERRIS A","ppno":2766703300,"pcpadd":"1107 Brookdale St","pcpcity":"Martinsville","pcpstate":"VA","pcpzip":241124501,"pcpcounty":"","pcpid":"P0117725","pcpname":"CARILION MEDICAL ASSOCIATES","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":["I89.0","I87.2","R60.0","L60.0","L60.2","B35.1","M79.674","M79.675","E11.41","L03.032","M79.89","E11.9","E78.5","I10","N18.3","R03.0","L97.828","L97.818","L97.228","L97.218","L97.808","T81.89XD","Z00.00","Z23","N17.9","M10.9","M62.81","R26.2","D64.9","J18.9","U07.1","L98.419","L98.8","E11.622","L97.821","I12.9","E11.22","N18.30","N18.4","E87.6","M10.031","Z11.52","Z79.899","Z20.828","R06.02","K44.9","M25.461","M25.462","M79.641","E87.2","N39.0","R53.1","Z20.822","E78.00","E86.0","L89.151","R53.81"],"date":["2020-12-30","2021-01-03","2021-01-19","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-09-01","2021-01-19","2021-01-19","2021-01-03","2021-02-01","2020-07-28","2020-07-20","2020-08-06","2020-08-06","2020-09-03","2020-09-03","2020-04-01","2020-12-30","2020-01-07","2020-01-07","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-10","2021-02-10","2020-11-16","2020-11-16","2021-01-03","2021-01-03","2020-11-16","2021-01-03","2021-01-19","2021-01-03","2021-01-03","2021-01-03","2021-01-03","2021-01-05","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-01-19"],"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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}