{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NANCY   A CARVER","gend":1,"add":"1520 ARTISAN WELLS HOLLOW ROAD","city":"BIG STONE GAP","state":"VA","zip":"24219-4410","dob":"1962-04-21","age":"","mstatus":"","insh":7739077,"cliId":"","pno":4234303155,"cno":4234303155,"email":"","ename":"","eno":"","pphy":"WINEGAR, J B","ppno":2764312648,"pcpadd":"121 Robbins Family Dr, ","pcpcity":"Duffield","pcpstate":"VA","pcpzip":242444784,"pcpcounty":"","pcpid":"","pcpname":"HOLSTON MEDICAL GROUP PC","ano":2765240557,"add2":"APT 104","add3":"","madd1":"1520 ARTISAN WELLS HOLLOW ROAD","madd2":"APT 104","madd3":"","mcity":"BIG STONE GAP","mstate":"VA","mzip":"24219-4410","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","I65.23","I65.01","I77.1","I10","F17.210","I73.9","E04.2","Z95.1","I25.10","I34.8","F17.200","E78.5","I69.351","J42","E55.9","E53.8","R60.9","N18.2","I65.21","E78.2","E11.21","I63.9","I65.29","H53.8","I48.0","I12.9","I70.203","Z23","G45.9"],"date":["2021-04-01","2019-10-14","2019-10-14","2019-10-14","2021-04-01","2020-04-24","2020-10-20","2019-10-14","2019-10-14","2020-10-19","2020-10-19","2020-09-21","2021-03-31","2021-03-31","2021-03-31","2020-09-21","2020-09-21","2019-12-10","2020-09-21","2020-10-19","2020-04-24","2020-09-21","2020-05-22","2020-09-21","2020-09-21","2020-10-19","2021-03-31","2019-10-14","2019-12-10","2019-12-10"],"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":[["","00904615760","VITAMIN ","TAB 2000UNIT","60","Select","Select",""],["","68382002210","ATENOLOL ","TAB 25MG","30","Select","Select",""],["","68382075810","METFORMIN ","TAB 500MG","60","Select","Select",""],["","12843013105","BAYER ","CHW 81MG","30","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","00378395377","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","00378020810","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","00069046903","CHANTIX ","PAK 1MG","56","Select","Select",""],["","00536589688","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","45802026937","PERMETHRIN ","CRE 0.05","60","Select","Select",""],["","00254100752","ALBUTEROL ","AER HFA","13.4","Select","Select",""],["","40985027111","D3 ","TAB 2000UNIT","100","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","25","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}