{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAUREN   B VAUGHAN","gend":1,"add":"C\/O KIMBERLY OR MARK VAUGHAN 200 MULBERRY DR","city":"CHRISTIANSBURG","state":"VA","zip":"24073-9998","dob":"1992-03-11","age":"","mstatus":"","insh":"20036635*01","cliId":"","pno":"540\/998-5467","cno":"540\/998-5467","email":"","ename":"","eno":"","pphy":"MOGEN, THOMAS MD","ppno":"540\/381-6000","pcpadd":"205 ROANOKE ST","pcpcity":"CHRISTIANSBURG","pcpstate":"VA","pcpzip":24073,"pcpcounty":"","pcpid":147705,"pcpname":"Carilion Clinic Family Medicine Christiansburg Satellite","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/381-2989","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G80.1","R62.50","R26.9","R25.2","Z30.41","G80.9","M24.571","M24.572","B00.1","M25.371","M25.372","G24.9"],"date":["2021-10-06","2021-10-06","2021-10-06","2021-10-06","2020-06-03","2020-06-03","2020-06-03","2021-02-10","2020-06-03","2021-02-10","2021-02-10","2021-10-06"],"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":[["","63824000832","MUCINEX ","600MG ER","40","Select","Select",""],["","68180084413","KURVELO ","0.15\/30","28","Select","Select",""],["","55111018010","TIZANIDINE ","4MG","90","Select","Select",""],["","52817032110","BACLOFEN ","20MG","180","Select","Select",""],["","00378655053","LEVONOR\/ETHI ","ESTRADIO","84","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","59779070352","12HR ","120MG CR","10","Select","Select",""],["","59779070352","12HR","120MG CR","10","Select","Select",""],["","63824000832","MUCINEX","600MG ER","40","Select","Select",""],["","68180084413","KURVELO","0.15\/30","28","Select","Select",""],["","55111018010","TIZANIDINE","4MG","90","Select","Select",""],["","52817032110","BACLOFEN","20MG","180","Select","Select",""],["","00378728590","LEVONOR\/ETHI","ESTRADIO","91","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","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","",""],["No","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":""}]}]}