{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" DAYNA K KARBOWSKI","gend":1,"add":"PO BOX 314","city":"FLOYD","state":"VA","zip":"24091-0314","dob":"1988-08-10","age":"","mstatus":"","insh":4269284,"cliId":"","pno":"5407446559, 5407446559","cno":5405773983,"email":"","ename":"","eno":"","pphy":"BEATO, GREGORY C","ppno":"               ","pcpadd":"810 Hospital Dr, ","pcpcity":"Blacksburg","pcpstate":"VA","pcpzip":240607023,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"VPM4","region":"ROANOKE","aligned":"","ano":"","add2":"LOT 2","add3":"","madd1":"PO BOX 314","madd2":"LOT 2","madd3":"","mcity":"FLOYD","mstate":"VA","mzip":"24091-0314","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05","J45.909","F12.90","H66.93","R06.02","I50.9","F17.200","Z72.0","L23.7","S00.83XA","R51","Y04.2XXA","Y93.9","Y92.9","S40.021A","M62.838","Z86.19","F17.210","H53.149","R42","Y09","J45.40","R06.2","R74.8","D58.2","Z86.59","R07.89","R00.2","R06.83","R53.83","B18.2","R10.9","E27.9","K02.9","R10.84","J44.9","S09.90XA","F43.21","R68.89","L25.5","J45.21","M54.2"],"date":["2019-05-08","2019-09-03","2019-08-28","2019-01-22","2019-05-09","2019-01-22","2019-01-22","2019-01-22","2019-05-08","2019-09-04","2019-09-04","2019-09-03","2019-09-03","2019-09-03","2019-09-04","2019-09-03","2019-09-03","2020-02-15","2019-09-04","2019-09-04","2019-09-04","2019-04-29","2019-04-29","2019-04-29","2019-04-29","2019-04-29","2019-05-09","2019-05-09","2019-05-09","2019-05-09","2019-05-09","2020-02-15","2020-02-15","2020-02-15","2020-02-15","2020-02-15","2019-09-04","2021-05-20","2019-02-21","2019-05-08","2019-05-08","2019-09-04"],"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":[["","00781261305","AMOXICILLIN ","CAP 500MG","14","Select","Select",""],["","00054001829","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","61442010305","DICLOFENAC ","TAB 75MG DR","30","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","76204020025","ALBUTEROL ","NEB 0.00083","75","Select","Select",""],["","16571040110","CETIRIZINE ","TAB 5MG","24","Select","Select",""],["","63736012002","NIX ","LIQ 0.01","59","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","00173071820","FLOVENT ","AER 44MCG","10.6","Select","Select",""],["","66993058497","FLUTIC\/SALME ","AER 100\/50","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":""}]}]}