{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BILLY R BROWN","gend":0,"add":"35 OAK ST APT B12 ","city":"ROCKY MOUNT ","state":"VA","zip":"24151-9998","dob":"1941-06-13","age":"","mstatus":"","insh":11014457,"cliId":"6FK2RC6EP80","pno":5404837842,"cno":5404837842,"email":"","ename":"","eno":"","pphy":"STUBBS, SARAH  ","ppno":5409817653,"pcpadd":"180 Floyd Ave","pcpcity":"Rocky Mount ","pcpstate":"VA","pcpzip":241511318,"pcpcounty":"","pcpid":"P0156177","pcpname":"CARILION CLINIC FAMILY MEDICINE ROCKY MT FRKN RH","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"20 KEG VALLEY LANE","madd2":"","madd3":"","mcity":"ROCKY MOUNT ","mstate":"VA","mzip":"24151-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","I25.10","M48.061","F51.04","K21.9","Z86.73","R73.03","K52.9","J06.9","M51.37"],"date":["2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22"],"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":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","43386035701","HYDROCO\/APAP","7.5-325","120","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","48","Select","Select",""],["","27241013436","CHOLESTYRAM","4GM","30","Select","Select",""],["","57237016199","OMEPRAZOLE","20MG","90","Select","Select",""],["","65862049001","QUETIAPINE","50MG","90","Select","Select",""],["","65862035790","CLOPIDOGREL","75MG","90","Select","Select",""],["","69097096607","NABUMETONE","750MG","180","Select","Select",""],["","50742024890","DILTIAZEM","120MG ER","90","Select","Select",""],["","69097094312","GABAPENTIN","300MG","270","Select","Select",""],["","52544069119","MATZIM","180MG\/24","90","Select","Select",""],["","43386035701","HYDROCO\/APAP ","TAB 7.5-325","120","Select","Select",""],["","27241013436","CHOLESTYRAM ","POW 4GM","30","Select","Select",""],["","57237016199","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","48","Select","Select",""],["","50742024890","DILTIAZEM ","CAP 120MG ER","90","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","270","Select","Select",""],["","52544069119","MATZIM ","TAB 180MG\/24","90","Select","Select",""],["","65862035790","CLOPIDOGREL ","TAB 75MG","90","Select","Select",""],["","69097096607","NABUMETONE ","TAB 750MG","180","Select","Select",""],["","65862049001","QUETIAPINE ","TAB 50MG","90","Select","Select",""]]}},{"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","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","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":""}]}]}