{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLARENCE WALLACE","gend":0,"add":"8700 KESWICK DR APT 315","city":"SPOTSYLVANIA","state":"VA","zip":"22551-9998","dob":"1984-10-04","age":"","mstatus":"","insh":"2193123*01","cliId":"","pno":5404985252,"cno":5404985252,"email":"","ename":"","eno":"","pphy":"ORR, KIMBERLY R DO","ppno":5409660400,"pcpadd":"150 MARKET RIDGE LN,","pcpcity":"DALEVILLE","pcpstate":"VA","pcpzip":"24083-9998","pcpcounty":"","pcpid":"","pcpname":"Carilion Healthcare Corp","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5409926669,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N30.00","F28.","F25.0","F29.","F32.9","NO DATA","F10.10","R07.89","R07.9","R44.0","D72.829","Z04.6","Z03.818","F25.1"],"date":["2022-01-18","2022-01-18","2022-01-24","2022-02-24","2021-11-13","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2022-01-16","2022-01-16","2022-01-16","2022-01-16","2022-01-26"],"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":[["","70710122600","AMITRIPTYLIN TAB","25MG","30","Select","Select",""],["","00228202950","ALPRAZOLAM TAB","0.5MG","30","Select","Select",""],["","68180012202","CEPHALEXIN CAP","500MG","4","Select","Select",""],["","49100040007","CULTURELLE CAP","","11","Select","Select",""],["","00832155011","HALOPERIDOL TAB","10MG","30","Select","Select",""],["","00093342210","CYCLOBENZAPRINE HCL","10 MG","15","Select","Select",""],["","16571020210","DICLOFENAC SODIUM","50 MG","60","Select","Select",""],["","43547030303","ARIPIPRAZOLE","5 MG","30","Select","Select",""],["","65162019050","NAPROXEN","500 MG","15","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":""}]}]}