{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARLA M ABATE","gend":1,"add":"800 W RIDGEWAY STREET","city":"CLIFTON FORGE  ","state":"VA","zip":"24422-1393","dob":"1968-06-11","age":"","mstatus":"","insh":11017040,"cliId":"4DT8N03GK61","pno":5409698315,"cno":5409698315,"email":"","ename":"","eno":"","pphy":"CALDRONEY, RALPH D","ppno":5404583344,"pcpadd":"1 Health Cir","pcpcity":"Lexington","pcpstate":"VA","pcpzip":244502448,"pcpcounty":"","pcpid":"P9348563","pcpname":"CARILION CLINIC FAMILY MEDICINE CLIFTON FORGE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"APT 104  ","add3":"","madd1":"800 W RIDGEWAY STREET","madd2":"APT 104  ","madd3":"","mcity":"CLIFTON FORGE  ","mstate":"VA","mzip":"24422-1393","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R53.81","M79.89","R60.0","E78.5","I82.409","Z86.73","Z79.01","M79.605","R53.1","M79.662","R68.89"],"date":["2021-09-01","2021-10-25","2021-10-24","2021-07-16","2021-07-16","2021-10-24","2021-05-05","2021-10-24","2021-10-24","2021-10-25","2021-10-24"],"priorHcc":["","",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":[["","50458057930","XARELTO","TAB 20MG","","Select","Select",""],["","60505257908","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","","Select","Select",""],["","60505257908","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","50458057930","XARELTO ","TAB 20MG","30","Select","Select",""],["","65862001205","SERTRALINE ","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","",""],["Yes","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":""}]}]}