{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTANY   N BONDS","gend":1,"add":"1358   STOVER SCHOOL ROAD                                   ","city":"GREENVILLE                    ","state":"VA","zip":"24440-2005","dob":"1992-02-20","age":"","mstatus":"","insh":10050876,"cliId":"","pno":5406799886,"cno":5406799886,"email":"","ename":"","eno":"","pphy":"DEBELAK, JACOB P                                            ","ppno":"","pcpadd":"1906 Belleview Ave SE","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240141838,"pcpcounty":"","pcpid":"P0117745","pcpname":"CARILION ROANOKE MEMORIAL HOSPITALISTS","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1358   STOVER SCHOOL ROAD                                   ","madd2":"                                                            ","madd3":"","mcity":"GREENVILLE                    ","mstate":"VA","mzip":"24440-2005","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.2","S16.1XXA","M25.511","M62.838","Z88.8","Z88.1","M54.5","Z23","M25.561","R26.89","S06.9X9S","Z98.51","G89.29","M41.9","R11.0","R42","R51","Z87.820","R41.82","M47.816","M79.18","Z01.419","Z13.9","Z12.4","N92.6","E66.01","Z68.42","R07.89","R53.1","Z79.899","R07.9","R20.2","M79.605","S86.812A","X58.XXXA","Y93.9","S86.902A","M79.662","Z20.822","B89"],"date":["2019-02-09","2019-02-09","2019-02-09","2019-02-09","2021-09-18","2021-09-18","2020-07-08","2021-11-01","2019-02-19","2019-02-19","2019-02-19","2019-02-19","2020-07-08","2019-03-22","2019-04-24","2019-04-24","2019-04-24","2019-04-24","2019-04-24","2019-07-30","2019-05-10","2020-06-23","2020-06-23","2020-06-23","2020-06-23","2020-09-21","2020-07-08","2020-09-07","2020-09-07","2021-09-18","2020-09-07","2020-09-07","2020-09-21","2020-09-21","2020-09-21","2020-09-21","2020-09-21","2020-09-21","2021-09-18","2021-09-20"],"priorHcc":["","","","","","","",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":[]},{"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":[["","57237001830","DULOXETINE","30MG","30","Select","Select",""],["","00904671960","ACETAMINOPHE","325MG","90","Select","Select",""],["","49035039312","EQ","200MG","30","Select","Select",""],["","49348072710","SM","200MG","30","Select","Select",""],["","68645056259","IBUPROFEN","600MG","21","Select","Select",""],["","57237001830","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","00904671960","ACETAMINOPHE ","TAB 325MG","90","Select","Select",""],["","49035039312","EQ ","TAB 200MG","30","Select","Select",""],["","49348072710","SM ","TAB 200MG","30","Select","Select",""],["","68645056259","IBUPROFEN ","TAB 600MG","21","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","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}