{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTHONY CHITWOOD","gend":0,"add":"270 ELK LANE                                                ","city":"FERRUM                        ","state":"VA","zip":"24088-3384","dob":"1980-09-22","age":"","mstatus":"","insh":10265166,"cliId":"","pno":5402384214,"cno":"","email":"","ename":"","eno":"","pphy":"DULANEY, KIMBERLY A                                         ","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":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"270 ELK LANE                                                ","madd2":"                                                            ","madd3":"","mcity":"FERRUM                        ","mstate":"VA","mzip":"24088-3384","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","B18.2","G40.909","F41.9","Z02.89","Z23","R56.9"],"date":["2020-12-21","2021-05-19","2021-08-18","2021-05-19","2021-08-18","2021-09-29","2021-10-11"],"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":[["","68382014005","TOPIRAMATE","100MG","90","Select","Select",""],["","69097084705","ESCITALOPRAM","5MG","30","Select","Select",""],["","10702001110","HYDROXYZ","25MG","90","Select","Select",""],["","62756079813","DIVALPROEX","500MG DR","180","Select","Select",""],["","00074262528","MAVYRET","100-40MG","84","Select","Select",""],["","65862001205","SERTRALINE","50MG","30","Select","Select",""],["","68382014005","TOPIRAMATE ","TAB 100MG","90","Select","Select",""],["","69097084705","ESCITALOPRAM ","TAB 5MG","30","Select","Select",""],["","10702001110","HYDROXYZ ","TAB 25MG","90","Select","Select",""],["","00131247835","VIMPAT ","TAB 100MG","60","Select","Select",""],["","62756079813","DIVALPROEX ","TAB 500MG DR","180","Select","Select",""],["","00074262528","MAVYRET ","TAB 100-40MG","84","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","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","",""],["N\/A","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":""}]}]}