{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA   C POWELL","gend":1,"add":"7451 DAWNWOOD ROAD","city":"ROANOKE","state":"VA","zip":"24018-9998","dob":"1984-08-02","age":"","mstatus":"","insh":"1995653*01","cliId":"","pno":"540\/580-4034","cno":"","email":"","ename":"","eno":"","pphy":"OMALLEY, MOLLY E DO","ppno":"540\/725-7800","pcpadd":"3707 BRAMBLETON AVE SW SUITE 2","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24018,"pcpcounty":"","pcpid":"","pcpname":"Carilion Family Medicine Brambleton","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/989-6752","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","R10.2","Z30.432","R51.","N76.0","Z23.","Z20.5","Z30.09","M25.521","R20.2","M54.9","O34.211","Z3A.39","Z37.0","O99.824","O34.219","Z3A.00","R09.81","Z01.818","R00.2","G44.209","K21.9","Z32.01","F17.200","Z98.891"],"date":["2020-01-17","2020-01-17","2021-10-14","2020-05-21","2020-09-28","2020-09-28","2021-10-14","2021-10-14","2019-09-11","2019-09-11","2019-09-11","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2021-11-13","2020-11-02","2021-01-22","2021-01-22","2021-01-22","2020-04-06","2020-04-06","2020-04-06"],"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":[["","","PREDNISONE"," PREDNISONE ","21","Select","Select",""],["","","BACLOFEN"," BACLOFEN ","30","Select","Select",""],["","","BUT\/APAP\/CAF","CAP ","","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","","VITAMIN","CAP 2000UNIT","","Select","Select",""],["","","ACYCLOVIR","TAB 400MG","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","PROMETHAZINE","TAB 12.5MG","","Select","Select",""],["","","APAP\/CODEINE","TAB 300-30MG","","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":[]}},{"a":{"indx":["","1"],"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":""}]}]}