{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESA A CLINGENPEEL","gend":1,"add":"6583 STONES KEEP LN LOT 38","city":"ELLISTON","state":"VA","zip":"24087-9998","dob":"1964-01-20","age":"","mstatus":"","insh":"20025502*01","cliId":"","pno":5402306181,"cno":5402306181,"email":"","ename":"","eno":"","pphy":"GARDNER, KIRSTEN DO","ppno":5403870441,"pcpadd":"1935 W MAIN ST","pcpcity":"SALEM","pcpstate":"VA","pcpzip":"24153-9998","pcpcounty":"","pcpid":"","pcpname":"Carilion Healthcare Corp","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5403897868,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R41.82","I69.851","U07.1","R09.02","R53.1","I95.9","F32.9","NO DATA","R41.0","G93.41","R26.2","M62.81","Z86.011","G81.94","E55.9","R07.89","I10.","M79.603","T67.5XXA","T67.01XA","R40.4","R00.0","R50.9","K64.9","R07.9","R63.0","G30.9","F02.80","F32.0","Z23.","F03.90","M25.552","M79.672","M19.072","B35.3","R94.31","J96.01","Z86.16","M54.12","F81.9","L98.9","Z85.828","D48.5","G81.92","N17.9","Z66.","Z79.82","Z87.891","E86.0","I73.9","Z88.6","Z91.040","Z88.5"],"date":["2021-08-30","2021-08-18","2021-10-21","2021-09-03","2021-10-12","2021-08-18","2021-10-12","2023-05-05","2021-08-18","2021-10-01","2021-10-01","2021-10-01","2021-11-11","2021-10-01","2021-10-12","2022-04-22","2022-04-22","2021-02-13","2021-08-13","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-10-12","2022-04-22","2021-08-16","2021-11-11","2021-11-11","2021-10-12","2022-11-22","2021-10-21","2021-10-21","2021-01-14","2021-01-14","2021-01-14","2021-08-16","2021-09-03","2021-11-11","2021-11-11","2021-11-11","2022-11-22","2022-11-22","2023-02-14","2021-09-03","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18"],"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":[]},{"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":[["","68180047903","SIMVASTATIN","20 MG","90","Select","Select",""],["","65162037110","OXYBUTYNIN CHLORIDE ER","5 MG","30","Select","Select",""],["","11917020311","","","90","Select","Select",""],["","00904674759","IBUPROFEN","200 MG","30","Select","Select",""],["","68382002101","VENLAFAXINE HCL","75 MG","90","Select","Select",""],["","43547027511","DONEPEZIL HCL","5 MG","90","Select","Select",""],["","43547027509","DONEPEZIL","TAB 5MG","30","Select","Select",""],["","68382002101","VENLAFAXINE","TAB 75MG","30","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":""}]}]}