{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CASSANDRA   M HERRING","gend":1,"add":"1014 PAGE ST APT B","city":"SALEM","state":"VA","zip":"24153-9998","dob":"1984-10-20","age":"","mstatus":"","insh":"20044006*01","cliId":"","pno":"804\/840-7062","cno":"804\/840-7062","email":"","ename":"","eno":"","pphy":"PERKINS, KAREN E MD","ppno":"540\/562-5700","pcpadd":"C C FAM MED R SALEM 1314 PETERS CRE","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24017,"pcpcounty":"","pcpid":137700,"pcpname":"Inpatient Carilion Roanoke Memorial Hospital","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S90.421A","L97.514","L97.512","L97.511","M86.171","M86.10","A41.9","K61.1","Z51.5","Z20.828","Z68.43","L02.214","E11.65","E78.5","I10.","F41.9","E66.01","Z79.82","Z79.4","L03.90","R07.9","V58.89","E11.628","E66.9","E11.9","E11.3523","H40.052","R06.83","R06.81","E11.42","L60.3","G47.33","R06.09","Z82.49","Z87.39","F43.22","F41.0","Z23.","Z30.09","S71.101A","H43.12","E11.3532","R07.89","R00.2","H25.13","H43.13","E11.3592","E11.3521","R09.02","I47.1","L02.91","Z98.890","Z48.810","M20.5X1","M21.6X1","S90.211A","S90.221A","M20.41","L03.314","L02.415","E11.40","T81.89XA","R06.02","R51.9","K08.89","H35.89","H33.42","R10.9","R11.2","M20.42","I12.9","N18.2","E11.3522","Z30.011","E66.2","Z68.44"],"date":["2020-06-04","2020-12-03","2020-09-03","2020-12-03","2020-03-05","2020-03-05","2020-09-20","2020-10-26","2020-09-20","2020-09-20","2020-12-23","2020-09-20","2020-11-09","2020-11-09","2021-05-28","2020-10-26","2020-11-09","2020-09-20","2021-07-09","2020-09-20","2020-09-23","2020-10-28","2020-10-28","2020-12-23","2021-05-28","2021-07-09","2020-12-11","2020-12-23","2020-12-23","2021-03-15","2021-03-15","2021-06-22","2020-09-11","2020-07-23","2020-07-23","2020-09-08","2020-09-08","2020-11-05","2020-09-08","2020-10-01","2021-07-09","2020-12-21","2020-08-17","2020-08-24","2020-10-22","2020-11-12","2020-02-12","2020-02-12","2020-09-22","2020-08-21","2020-09-20","2021-01-21","2020-11-12","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2020-06-04","2020-09-20","2020-10-21","2020-10-01","2020-10-21","2020-11-05","2021-03-21","2021-03-21","2021-01-21","2021-01-21","2020-02-14","2020-02-14","2020-09-03","2020-11-05","2020-11-05","2020-11-11","2021-05-28","2021-05-28","2021-05-28"],"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":[[["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":""}]}]}