{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTOPHER S BALLARD","gend":0,"add":"135 RAYMOND LN ","city":"NARROWS  ","state":"VA","zip":"24124-9998","dob":"1975-04-03","age":"","mstatus":"","insh":11016399,"cliId":"9R17WE1FW66","pno":2767220512,"cno":"","email":"","ename":"","eno":"","pphy":"GLENNEY, ROBERT","ppno":5402541239,"pcpadd":"18080 Main St","pcpcity":"Buchanan ","pcpstate":"VA","pcpzip":240665482,"pcpcounty":"","pcpid":"P0125206","pcpname":"CARILION CLINIC FAMILY MEDICINE GILES RURAL HEALTH","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"135 RAYMOND LN ","madd2":"","madd3":"","mcity":"NARROWS  ","mstate":"VA","mzip":"24124-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M54.5","S32.010G","Z51.81","F11.20","Z79.899","K04.7","R68.84","Z90.49","F17.210","R22.0","L60.0","L60.2","B35.1","M79.674","M79.675"],"date":["2020-10-20","2020-10-20","2020-10-20","2021-11-22","2020-10-20","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04"],"priorHcc":["","","",null,"","","","","","",null,null,null,null,null]}},{"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":[["","65862050320","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","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":""}]}]}