{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER   L MOORE","gend":1,"add":"2314 AVENEL AVE ROANOKE","city":"ROANOKE","state":"VA","zip":"24015-9998","dob":"1980-01-22","age":"","mstatus":"","insh":"1907125*01","cliId":"","pno":"540\/510-5480","cno":"540\/510-5480","email":"","ename":"","eno":"","pphy":"WHITNEY, WILLIAM MD","ppno":"540\/772-0555","pcpadd":"3369 COLONIAL AVE","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24018,"pcpcounty":"","pcpid":147705,"pcpname":"Carilion Clinic Family Medicine Colonial Ave","plan":"OHP","program":"ACA","lob":"Small Group","region":"ROANOKE ALLEGHANY","aligned":"","ano":"540\/423-2977","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/772-1360","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R00.0","F12.99","T88.7XXA","R00.2","R61.","F12.90","Z01.419","N92.6","H53.9","F41.1","R06.02","F41.0","Z20.828","R55.","R42.","H53.8","F17.200","T40.7X4A","F17.210","D22.9","L81.4","W89.1XXA","Z80.8","Z11.59","R94.31"],"date":["2020-11-12","2020-11-12","2020-11-12","2021-06-20","2020-11-12","2020-11-12","2021-04-16","2021-04-16","2021-06-11","2021-06-23","2021-06-20","2021-06-23","2020-08-09","2021-06-03","2021-06-03","2021-06-03","2021-06-20","2020-11-12","2020-11-12","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-08-09","2020-11-12"],"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":[]},{"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","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}