{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRYAN STEWART","gend":0,"add":"6910 WILLIAMSON RD NORTH ROANOKE ALF","city":"ROANOKE","state":"VA","zip":"24019-9998","dob":"1958-11-19","age":"","mstatus":"","insh":"1760121*01","cliId":"","pno":"540\/521-7874","cno":"","email":"","ename":"","eno":"","pphy":"KHAWAM, SOUHA MD","ppno":"540\/387-0441","pcpadd":"1935 W MAIN ST","pcpcity":"SALEM","pcpstate":"VA","pcpzip":"24153","pcpcounty":"","pcpid":"","pcpname":"Carilion Clinic Primary Care Associates Salem","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/389-7868","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23.","I10.","E10.9","E87.1","E83.42","E87.6","R29.6","R42.","R26.9","R00.1","E11.40","E61.0","E55.9","R27.0","F84.5","R94.31","H54.7","Z86.718","Z91.81","Z79.4","I51.7","S01.81XA","R21.","S01.112A","R11.2","W19.XXXA","E11.65","I49.1"],"date":["2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-12-23","2021-09-10","2021-04-09","2021-04-09","2021-12-23","2021-04-09","2021-12-23","2021-12-23","2021-12-23","2021-09-08","2021-09-08","2021-04-09","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-01-07","2021-01-07","2021-07-07","2021-01-07","2021-01-07","2021-01-07","2021-05-27","2021-01-07"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00378459577","METOPROLOL","TAB 25MG ER","84","Select","Select",""],["","68180051709","LISINOPRIL","TAB 40MG","28","Select","Select",""],["","00002821501","HUMULIN","INJ U-100","10","Select","Select",""],["","08222032591","INSULIN","MIS 0.5\/29G","150","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00603020922","MAG","TAB 400MG","20","Select","Select",""],["","00536379001","VITAMIN","CAP 2000UNIT","4","Select","Select",""],["","00378459577","METOPROL","TAB 25MG ER","84","Select","Select",""],["","08496280801","EASY","MIS LANC\/28G","100","Select","Select",""],["","50111032701","HYDRALAZINE","TAB 25MG","84","Select","Select",""],["","67877025180","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","38779010108","UREA","POW ","900","Select","Select",""]]}},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}