{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ETHEL   N CALLAWAY","gend":1,"add":"PO BOX 46                                                   ","city":"PENHOOK                       ","state":"VA","zip":"24137-0046","dob":"1964-10-13","age":"","mstatus":"","insh":10054627,"cliId":"","pno":5404933861,"cno":5405761066,"email":"","ename":"","eno":"","pphy":"GLENNEY, ROBERT                                             ","ppno":"","pcpadd":"18080 Main St","pcpcity":"Buchanan                      ","pcpstate":"VA","pcpzip":240665482,"pcpcounty":"","pcpid":"P0117439","pcpname":"CARILION OB GYN WESTLAKE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"PO BOX 46                                                   ","madd2":"                                                            ","madd3":"","mcity":"PENHOOK                       ","mstate":"VA","mzip":"24137-0046","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M75.41","M75.01","M75.111","M19.011","M25.511","M25.611","M79.671","H40.013","F43.21","S46.011A","E66.3","Z12.31","M75.121","M25.811","G89.18","M24.111","M94.211","M75.51","M62.81","M19.012","M25.512","M75.42","M75.112","E66.01","S43.422A","M75.22","M24.112","Z01.818","M75.122","M65.812","S46.212A","M94.212","S43.422D","H25.13","H52.03"],"date":["2020-01-02","2019-06-04","2019-05-08","2019-10-08","2019-06-04","2020-01-02","2019-07-28","2019-08-12","2019-08-26","2019-08-31","2019-08-31","2019-09-03","2019-10-08","2019-10-08","2020-12-29","2019-10-08","2019-10-08","2019-10-08","2020-01-02","2020-12-29","2021-06-01","2020-12-29","2020-11-14","2020-11-14","2020-11-23","2020-12-29","2020-12-29","2020-12-23","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2021-07-14","2021-03-04","2021-03-04"],"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":[["","00172392670","DIAZEPAM","5MG","2","Select","Select",""],["","43386035701","HYDROCO\/APAP","7.5-325","30","Select","Select",""],["","14539067501","HYDROXYZ","50MG","25","Select","Select",""],["","69097096607","NABUMETONE","750MG","60","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","12","Select","Select",""],["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","51672403601","ETODOLAC","500MG","60","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","2","Select","Select",""],["","43386035701","HYDROCO\/APAP ","TAB 7.5-325","30","Select","Select",""],["","14539067501","HYDROXYZ ","CAP 50MG","25","Select","Select",""],["","69097096607","NABUMETONE ","TAB 750MG","60","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","12","Select","Select",""],["","69097015907","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","51672403601","ETODOLAC ","TAB 500MG","60","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","",""],["Yes","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":""}]}]}