{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THOMAS C BUSH","gend":0,"add":"3523 GARDEN CITY BOULEVARD","city":"ROANOKE","state":"VA","zip":240145816,"dob":"1968-11-18","age":"","mstatus":"","insh":11016652,"cliId":"6RD9MX9TH17","pno":5406558359,"cno":5406763409,"email":"","ename":"","eno":"","pphy":"BROWN, BEVERLY","ppno":5404279200,"pcpadd":"2145 Mount Pleasant Blvd SE","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240143632,"pcpcounty":"","pcpid":"P0117333","pcpname":"CARILION FAMILY MEDICINE SOUTHEAST FAMILY MEDICAL","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":["R06.02","J18.9","R07.9","R91.8","Z87.01","J44.1","R51.9","J02.9","E11.40","G47.30","I10","E78.5","H91.90","K21.9","Z79.84","Z79.82","Z87.891","Z99.81","E11.9","A41.9","D72.829","E87.2","J96.10","J44.9","E11.65","J84.9","G89.29","M54.5","F41.9","Z79.4","M54.9","J15.9","Z23","Z20.828","J43.9","F41.1","F41.0","M47.816","F32.9","R00.0","J44.0"],"date":["2021-01-20","2021-01-06","2021-01-06","2021-01-06","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-02-11","2020-12-25","2020-12-24","2020-12-24","2020-12-25","2020-12-24","2020-12-24","2020-12-24","2020-12-25","2020-12-24","2020-12-25","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-25"],"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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","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":""}]}]}