{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAHRBANOU OMRANI","gend":1,"add":"1609 HONEYSUCKLE DR","city":"BLACKSBURG","state":"VA","zip":"24060-9998","dob":"1943-10-15","age":"","mstatus":"","insh":"20032908*01","cliId":"","pno":"540\/818-2954","cno":"","email":"","ename":"","eno":"","pphy":"THOMPSON, CHAD R MD","ppno":"540\/951-0352","pcpadd":"SUITE 1 901 PLANTATION RD","pcpcity":"BLACKSBURG","pcpstate":"VA","pcpzip":24060,"pcpcounty":"","pcpid":"","pcpname":"Carilion Family Medicine Blacksburg","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/951-7724","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","E03.9","N18.3","Z96.1","D23.111","H02.831","H02.834","H04.123","H52.4","M25.551","M70.61","M16.11","M25.511","M75.41","M54.31","Z91.81","M25.512","Z01.818","M54.16","R20.0","R20.2","M19.042","M19.011","M19.012","NO DATA","E21.3","M17.0","G47.00","Z23.","Z78.0","M25.50","Z86.69","G56.03","R06.01","R06.00","R13.10"],"date":["2021-05-28","2021-03-24","2020-05-12","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2020-03-17","2020-02-19","2020-02-19","2021-03-24","2020-02-19","2020-02-19","2020-02-19","2021-03-24","2020-06-26","2020-06-29","2021-03-24","2021-04-12","2021-03-24","2021-03-24","2021-03-24","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2020-01-27","2020-01-27","2020-12-28","2020-12-28","2021-04-12","2021-05-28","2021-05-28","2021-05-28"],"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":[["","68382013616","LOSARTAN","TAB 50MG","10","Select","Select",""],["","","TRAZODONE","TAB 100MG","","Select","Select",""],["","69238183401","LEVOTHYROXIN","TAB 100MCG","15","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0","Select","Select",""],["","","FLUZONE","INJ PF 20-21","","Select","Select",""],["","","SHINGRIX","INJ 50\/0.5ML","","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":""}]}]}