{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"COLT R EVANS","gend":0,"add":"307 KNOB ST APT 12","city":"RICH CREEK","state":"VA","zip":"24147-9998","dob":"1989-12-12","age":"","mstatus":"","insh":"20051176*01","cliId":"","pno":2763400642,"cno":2763400642,"email":"","ename":"","eno":"","pphy":"HAYES, SANDRA K NP","ppno":5405582400,"pcpadd":"981 LITTON LN,","pcpcity":"BLACKSBURG","pcpstate":"VA","pcpzip":"24060-9998","pcpcounty":"","pcpid":"","pcpname":"Carilion Giles Community Hospital","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5409535024,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F41.1","F31.81","F41.9","F22.","R07.9","F41.0","R00.1","F12.980","R94.31","Z01.818","M79.604","M79.605","J45.909","F17.210","R07.89","K21.9","F33.0","F84.0","E78.2","Z11.3","V62.84","NO DATA","Z20.822","R06.02","R11.0","R68.83","R19.7","R61.","F90.0","F17.200","Z79.899","M79.609","G47.00","Z00.00","R63.4"],"date":["2022-03-02","2022-05-26","2022-05-04","2022-05-31","2022-05-25","2023-04-03","2023-09-08","2022-05-23","2022-05-26","2022-05-26","2022-06-06","2023-04-03","2023-04-03","2023-04-03","2023-04-03","2023-04-03","2023-09-12","2022-12-12","2022-12-12","2022-12-12","2022-12-12","2022-05-26","2022-05-26","2022-05-26","2022-05-25","2022-05-25","2022-05-25","2022-05-25","2022-05-25","2023-05-01","2021-09-27","2023-04-03","2023-04-03","2021-04-28","2023-09-12","2023-09-12"],"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":[["","68462012605","GABAPENTIN","600 MG","150","Select","Select",""],["","68180029506","DULOXETINE","CAP 30MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00555097102","DEXTROAMPHETAMINE-AMPHETAMINE","5 MG","60","Select","Select",""],["","65862056090","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","64764073030","TRINTELLIX","10 MG","30","Select","Select",""],["","69584061110","METHOCARBAMOL","500 MG","15","Select","Select",""],["","50228043505","NAPROXEN","375 MG","20","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":""}]}]}