{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HAILEY   N KINSEY","gend":1,"add":"6500 GRAND RETREAT DRIVE                                    ","city":"ROANOKE                       ","state":"VA","zip":"24019-1900","dob":"1997-01-30","age":"","mstatus":"","insh":10200106,"cliId":"","pno":8013886280,"cno":"","email":"","ename":"","eno":"","pphy":"SPEAKER, MARCUS                                             ","ppno":"","pcpadd":"2145 Mount Pleasant Blvd SE","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240143632,"pcpcounty":"","pcpid":"P0117344","pcpname":"CARILION FAMILY MEDICINE ROANOKE SALEM","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APARTMENT 3057                                              ","add3":"","madd1":"6500 GRAND RETREAT DRIVE                                    ","madd2":"APARTMENT 3057                                              ","madd3":"","mcity":"ROANOKE                       ","mstate":"VA","mzip":"24019-1900","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H30.21","Z96.1","H35.061","H30.103","H35.372","H20.13","Z79.899","B36.0","L70.0","D22.5","H40.052","H53.19","H30.23","H57.11","N89.8","Z01.419","R10.2","R19.7","Z76.89","H20.9","M25.50","M25.551","M25.552","M79.18","F41.9","E55.9","M79.7"],"date":["2019-11-06","2019-11-06","2020-07-27","2020-11-02","2019-11-01","2020-07-01","2021-09-29","2021-04-27","2021-04-27","2020-05-27","2021-09-29","2020-11-02","2021-09-29","2020-11-02","2020-11-04","2020-11-04","2020-11-04","2021-09-13","2021-02-11","2021-09-13","2021-09-15","2021-02-17","2021-02-17","2021-05-13","2021-05-13","2021-09-13","2021-09-13"],"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":[["","68462011944","FLUCONAZOLE","150MG","12","Select","Select",""],["","00074055402","HUMIRA","40\/0.4ML","2","Select","Select",""],["","64980051305","TIMOLOL","0.25% OP","5","Select","Select",""],["","00054472831","PREDNISONE","5MG","45","Select","Select",""],["","52817033010","CYCLOBENZAPR","5MG","60","Select","Select",""],["","68382077501","METHOTREXATE","2.5MG","24","Select","Select",""],["","69315012710","FOLIC","1000MCG","30","Select","Select",""],["","00143980350","DOXYCYCL","100MG","30","Select","Select",""],["","00065924007","DUREZOL","0.05%","10","Select","Select",""],["","45802026337","CLINDAMYCIN","1%","60","Select","Select",""],["","80777027398","MODERNA","COVID-19","0.5","Select","Select",""],["","68462011944","FLUCONAZOLE ","TAB 150MG","12","Select","Select",""],["","00074055402","HUMIRA ","INJ 40\/0.4ML","2","Select","Select",""],["","64980051305","TIMOLOL ","SOL 0.25% OP","5","Select","Select",""],["","00054472831","PREDNISONE ","TAB 5MG","45","Select","Select",""],["","52817033010","CYCLOBENZAPR ","TAB 5MG","60","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","68382077501","METHOTREXATE ","TAB 2.5MG","24","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","30","Select","Select",""],["","00143980350","DOXYCYCL ","CAP 100MG","30","Select","Select",""],["","00065924007","DUREZOL ","EMU 0.0005","10","Select","Select",""],["","45802026337","CLINDAMYCIN ","MIS 0.01","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","",""],["N\/A","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":""}]}]}