{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARCUS   T HICKMAN","gend":0,"add":"NEW RIVER COMMUNITY SERVICES                                ","city":"RADFORD                       ","state":"VA","zip":"24141-1431","dob":"1979-12-07","age":"","mstatus":"","insh":10055481,"cliId":"","pno":5405053000,"cno":5405053000,"email":"","ename":"","eno":"","pphy":"JONES, BRITTANY DIXON                                       ","ppno":"","pcpadd":"3700 S Main St","pcpcity":"Blacksburg                    ","pcpstate":"VA","pcpzip":240607017,"pcpcounty":"","pcpid":"P0124253","pcpname":"CHRISTIANSBURG INTERNAL MEDICINE LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"613   2ND STREET                                            ","add3":"","madd1":"NEW RIVER COMMUNITY SERVICES                                ","madd2":"613   2ND STREET                                            ","madd3":"","mcity":"RADFORD                       ","mstate":"VA","mzip":"24141-1431","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.0","M54.5","I10","F20.9","F17.200","Z79.899","E55.9","Z00.00","R25.1","F41.9","Z71.6","Z68.38","I34.0","R94.31","F31.75"],"date":["2021-05-03","2019-04-12","2021-06-07","2021-10-28","2019-04-12","2021-06-07","2019-08-22","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-07-19","2021-07-19","2021-08-21"],"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":[["","67877024710","QUETIAPINE","300MG","28","Select","Select",""],["","69315013710","BENZTROPINE","1MG","56","Select","Select",""],["","68180051201","LISINOPRIL","2.5MG","28","Select","Select",""],["","70069038305","HALOPER","100MG\/ML","1","Select","Select",""],["","30768019941","VITAMIN","50MCG","28","Select","Select",""],["","00135051001","NICORETTE","2MG MINT","144","Select","Select",""],["","45802034405","NICOTINE","2MG MINT","144","Select","Select",""],["","67877024710","QUETIAPINE ","TAB 300MG","28","Select","Select",""],["","69315013710","BENZTROPINE ","TAB 1MG","56","Select","Select",""],["","68180051201","LISINOPRIL ","TAB 2.5MG","28","Select","Select",""],["","70069038305","HALOPER ","INJ 100MG\/ML","1","Select","Select",""],["","30768019941","VITAMIN ","CAP 50MCG","28","Select","Select",""],["","00135051001","NICORETTE ","LOZ 2MG MINT","144","Select","Select",""],["","45802034405","NICOTINE ","LOZ 2MG MINT","144","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":""}]}]}