{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAUNA ATKINS","gend":1,"add":"104 BISHOP DR                                               ","city":"ROANOKE                       ","state":"VA","zip":"24019-8531","dob":"2001-12-27","age":"","mstatus":"","insh":10054592,"cliId":"","pno":5409663132,"cno":5409663132,"email":"","ename":"","eno":"","pphy":"PINEDA, MICHOLE M                                           ","ppno":"","pcpadd":"400 Liberty Hill Rd","pcpcity":"Lumberton                     ","pcpstate":"NC","pcpzip":283582446,"pcpcounty":"","pcpid":"P9058462","pcpname":"CARILION PEDIATRIC ASSOCIATES BOTETOURT","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"104 BISHOP DR                                               ","madd2":"                                                            ","madd3":"","mcity":"ROANOKE                       ","mstate":"VA","mzip":"24019-8531","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","F41.1","F90.2","F45.22","F43.12","F43.10","F39","F51.04","F44.9","R22.0","F98.8","R07.89","R10.11","M79.18","F17.200","Z82.49","H61.21"],"date":["2020-10-12","2020-10-12","2019-07-31","2020-10-12","2020-10-12","2021-11-04","2021-11-04","2020-05-01","2019-04-23","2020-02-01","2021-11-04","2021-11-06","2021-11-06","2021-11-06","2021-11-06","2021-11-06","2021-11-22"],"priorHcc":["","","","","",null,null,"","","",null,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":[]},{"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":[["","52817018000","CLONIDINE","0.1MG","60","Select","Select",""],["","59417010210","VYVANSE","20MG","30","Select","Select",""],["","00591544305","PREDNISONE","20MG","8","Select","Select",""],["","65862019401","FLUOXETINE","40MG","30","Select","Select",""],["","13668013610","ESCITALOPRAM","10MG","30","Select","Select",""],["","52817018000","CLONIDINE ","TAB 0.1MG","60","Select","Select",""],["","59417010210","VYVANSE ","CAP 20MG","30","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","8","Select","Select",""],["","65862019401","FLUOXETINE ","CAP 40MG","30","Select","Select",""],["","13668013610","ESCITALOPRAM ","TAB 10MG","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","",""],["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":""}]}]}