{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROLYN   D HUBBARD","gend":1,"add":"490   TANYARD  ROAD                                         ","city":"ROCKY MOUNT                   ","state":"VA","zip":"24151-1523","dob":"1960-12-23","age":"","mstatus":"","insh":10055513,"cliId":"","pno":2762247466,"cno":5403931280,"email":"","ename":"","eno":"","pphy":"ATIENZA, VERGEL S                                           ","ppno":"","pcpadd":"390 S Main St Ste 201","pcpcity":"Rocky Mount                   ","pcpstate":"VA","pcpzip":241511767,"pcpcounty":"","pcpid":"P0117675","pcpname":"CARILION MEDICAL ASSOCIATES ROCKY MOUNT","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT 302                                                     ","add3":"","madd1":"490   TANYARD  ROAD                                         ","madd2":"APT 302                                                     ","madd3":"","mcity":"ROCKY MOUNT                   ","mstate":"VA","mzip":"24151-1523","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B35.1","G60.9","R68.89","C50.912","M19.90","F32.9","E78.00","I10","Z90.12","Z92.3","Z98.890","Z88.8","Z79.899","Z85.3","E78.2","E78.5","C50.919","Z01.419","Z12.31","Z90.10","F32.89","M25.551","M16.11","M54.5","Z08","Z88.5","G89.29","M79.674","M79.675","R26.2","Z79.02","Z79.810","Z90.710","M25.571","M20.11","M21.071","Z12.39","Z78.0","N63.10","R92.8","D05.11","R59.0","Z92.21","D24.1","N63.14","R92.2","R92.1","N62","C50.311","Z17.1","F41.9","Z20.828","Z01.810","C50.911","N60.81","Z20.822","Z45.2","Z51.0","R73.01","Z23","C50.011","Z12.11","Z86.010"],"date":["2021-11-01","2021-11-01","2021-02-24","2020-12-08","2019-10-11","2020-11-09","2021-04-01","2021-09-22","2021-06-15","2020-10-14","2021-04-01","2021-04-01","2021-04-01","2021-10-11","2021-09-22","2020-11-09","2021-09-22","2021-10-06","2019-08-20","2021-10-06","2019-08-22","2019-10-25","2019-10-25","2019-10-25","2019-10-11","2019-10-11","2019-10-25","2019-12-16","2019-12-16","2019-12-16","2021-04-01","2021-06-15","2020-12-08","2020-09-28","2020-09-28","2020-09-28","2021-10-06","2020-10-05","2020-10-07","2020-10-14","2020-10-14","2020-10-14","2021-03-09","2020-10-14","2020-11-09","2020-10-14","2020-10-14","2020-11-09","2021-06-15","2021-06-15","2021-01-11","2020-11-05","2020-11-05","2021-06-15","2020-11-09","2021-01-11","2021-09-14","2021-04-09","2021-09-22","2021-09-22","2021-10-06","2021-10-11","2021-10-11"],"priorHcc":[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":[["","13668001005","CITALOPRAM","20MG","30","Select","Select",""],["","70377002711","ATORVASTATIN","10MG","30","Select","Select",""],["","49281042050","FLUZONE","2020-21","0.5","Select","Select",""],["","00591247330","TAMOXIFEN","20MG","30","Select","Select",""],["","80777027399","MODERNA","COVID-19","0.5","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","70461031903","FLUCLVX","2019-20","0.5","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0.5","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","13668001005","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","70377002711","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","Select","Select",""],["","00591247330","TAMOXIFEN ","TAB 20MG","30","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","70461031903","FLUCLVX ","INJ 2019-20","0.5","Select","Select",""],["","49281072010","FLUBLOK ","INJ 2020-21","0.5","Select","Select",""],["","45802065078","LORATADINE ","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","",""],["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":""}]}]}