{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELISSA G POLLARD","gend":1,"add":"102 Ridgewood Ln Apt H","city":"Radford","state":"VA","zip":241413624,"dob":"1971-04-12","age":"","mstatus":"","insh":11010383,"cliId":"1JP0UF5FX18","pno":5402392232,"cno":5408353919,"email":"","ename":"","eno":"","pphy":"MORGAN, BENJAMIN H","ppno":5407313200,"pcpadd":"701 Randolph St Ste 120","pcpcity":"Radford","pcpstate":"VA","pcpzip":241413047,"pcpcounty":"","pcpid":"P9443160","pcpname":"CARILION NEW RIVER VALLEY HOSPITAL","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"ROANOKE\/ALLEGHANY","aligned":"N","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M54.6","M79.18","R30.0","Z12.31","F41.1","F33.1","G47.09","F43.10","F41.0","N94.9","M72.2","M77.32","M79.672","Q66.70","F33.0","F41.9","G47.00","M54.41","R32","M54.5","R15.9","M25.512","V89.2XXA","S49.92XA","M54.2","G44.319","R45.89"],"date":["2020-01-22","2020-01-22","2020-05-19","2020-03-13","2020-10-22","2020-11-13","2020-08-25","2020-09-10","2020-12-01","2020-05-19","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-12-15","2020-12-15","2020-10-29","2020-11-24","2020-11-24","2020-11-23","2020-11-24","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-15"],"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":""}]}]}