{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHARLES   W STAGNER","gend":0,"add":"LINDA  ATCHISON                                             ","city":"STAUNTON                      ","state":"VA","zip":"24401-5959","dob":"1986-08-29","age":"","mstatus":"","insh":10053466,"cliId":"","pno":5406886736,"cno":5406886736,"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":"136   MILL LANE                                             ","add3":"","madd1":"LINDA  ATCHISON                                             ","madd2":"136   MILL LANE                                             ","madd3":"","mcity":"STAUNTON                      ","mstate":"VA","mzip":"24401-5959","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K08.409","K08.89","M54.5","Z87.442","A08.4","J30.2","J45.20","R00.2","R30.0","R39.9","F71","S46.912A","X58.XXXA","I10","Z23","R30.9","J02.9","J30.9","Z13.6","Z11.59","M62.838","R35.0","K59.00","E78.2"],"date":["2019-01-25","2019-01-25","2020-04-08","2019-02-27","2019-05-08","2021-07-30","2021-07-30","2021-02-24","2019-06-22","2021-01-02","2019-06-28","2019-08-27","2019-08-27","2021-07-30","2021-01-04","2019-12-30","2020-02-22","2020-06-03","2020-06-30","2020-06-03","2020-08-23","2021-01-02","2021-01-02","2021-08-03"],"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":[["","68645056054","MONTELUKAST","10MG","30","Select","Select",""],["","68382059505","DILTIAZEM","120MG ER","30","Select","Select",""],["","62037059790","CARTIA","120\/24HR","30","Select","Select",""],["","69097084615","CYCLOBENZAPR","10MG","15","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","20","Select","Select",""],["","61442010301","DICLOFENAC","75MG DR","30","Select","Select",""],["","68645056054","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","68382059505","DILTIAZEM ","CAP 120MG ER","30","Select","Select",""],["","62037059790","CARTIA ","CAP 120\/24HR","30","Select","Select",""],["","69097084615","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","20","Select","Select",""],["","61442010301","DICLOFENAC ","TAB 75MG DR","30","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":""}]}]}