{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONOVAN   T NOLAN","gend":0,"add":"305 CRAIG AVENUE                                            ","city":"VINTON                        ","state":"VA","zip":"24179-3418","dob":"2003-04-16","age":"","mstatus":"","insh":6950137,"cliId":"","pno":5403945841,"cno":5403945841,"email":"","ename":"","eno":"","pphy":"MERTEN, JOHN R                                              ","ppno":"","pcpadd":"1314 Peters Creek Rd Nw Ste 14","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240172500,"pcpcounty":"","pcpid":"P0117559","pcpname":"CARILION CLINIC COMMUNITY CARE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"305 CRAIG AVENUE                                            ","madd2":"                                                            ","madd3":"","mcity":"VINTON                        ","mstate":"VA","mzip":"24179-3418","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S11.90XA","S21.102A","S21.132A","M79.602","M54.2","R07.9","W34.010A","Y92.009","S41.132A","S11.83XA","Z79.51","Z79.899","S41.102A","S11.93XA","J45.20","J30.9","J30.1","S60.221A","S60.211A","Z00.3"],"date":["2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2020-10-14","2020-02-07","2020-10-14","2020-02-07","2020-02-07","2020-10-14"],"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":[["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","69097014260","ALBUTEROL","HFA","6.7","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","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":""}]}]}