{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARL   R RAMEY","gend":0,"add":"144 NEW LIGHT CHURCH ROAD PO BOX 4447","city":"MARTINSVILLE","state":"VA","zip":"24112-9998","dob":"1988-11-21","age":"","mstatus":"","insh":"20033730*01","cliId":"","pno":"276\/732-3098","cno":"276\/732-3098","email":"","ename":"","eno":"","pphy":"ROKHZAY JAFF, TWANA MD","ppno":"276\/670-3300","pcpadd":"1107A BROOKDALE ST","pcpcity":"MARTINSVILLE","pcpstate":"VA","pcpzip":24112,"pcpcounty":"","pcpid":147700,"pcpname":"Carilion Medical Associates Martinsville","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/634-0379","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M10.072","G47.33","E66.9","Z68.42","Z79.84","Z79.899","I10.","E11.9","Z86.39","J45.20","G40.A09","NO DATA","E03.9","Z23."],"date":["2020-10-12","2021-09-13","2021-09-13","2021-05-05","2021-05-05","2021-05-05","2021-09-13","2021-09-14","2021-04-26","2020-07-28","2020-07-28","2021-09-13","2021-09-13","2021-09-14"],"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":[["","76385011350","CARVEDILOL ","25MG","60","Select","Select",""],["","68180052001","LISINOP\/HCTZ ","20-25MG","30","Select","Select",""],["","00378180510","LEVOTHYROXIN ","75MCG","30","Select","Select",""],["","76385012810","METFORMIN ","500MG ER","120","Select","Select",""],["","80777027398","MODERNA ","COVID-19","0","Select","Select",""],["","68180046707","LOVASTATIN ","10MG","90","Select","Select",""],["","00254200801","COLCHICINE ","0.6MG","28","Select","Select",""],["","55111072901","ALLOPURINOL ","100MG","90","Select","Select",""],["","68180052001","LISINOP\/HCTZ","20-25MG","30","Select","Select",""],["","00378180510","LEVOTHYROXIN","75MCG","30","Select","Select",""],["","76385011350","CARVEDILOL","25MG","180","Select","Select",""],["","76385012810","METFORMIN","500MG ER","120","Select","Select",""],["","00254200801","COLCHICINE","0.6MG","28","Select","Select",""],["","68180046707","LOVASTATIN","10MG","90","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","55111072901","ALLOPURINOL","100MG","90","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","",""],["No","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":""}]}]}