{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HALEY T LE","gend":1,"add":"2622 DURHAM ST NW","city":"ROANOKE","state":"VA","zip":"24012-9998","dob":"1973-09-20","age":"","mstatus":"","insh":"2386927*01","cliId":"","pno":5407930233,"cno":5407930233,"email":"","ename":"","eno":"","pphy":"KEILMAN, DAVID MD","ppno":5402651607,"pcpadd":"4910 VALLEY VIEW BLVD,","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":"24012-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5403667353,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N92.0","D64.9","I10.","N93.9","R10.30","R42.","Z86.2","C54.1","E83.51","N94.6","D62.","G40.909","D63.0","Z76.89","N92.1","D50.0","Z09.","Z08.","Z85.42","Z90.710","Z90.79","Z90.722","Z71.3","Z71.82","E78.5","R03.0","Z01.810","D36.0","Z20.822","E44.1","D50.9","Z98.891"],"date":["2021-08-18","2021-08-18","2021-09-15","2021-09-15","2021-07-23","2021-07-25","2021-07-23","2021-09-28","2021-07-25","2021-07-25","2021-08-18","2021-08-18","2021-08-18","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2023-04-24","2023-04-24","2023-04-24","2023-04-24","2023-04-24","2023-04-24","2023-04-24","2021-07-26","2022-10-21","2021-09-15","2021-09-28","2021-07-25","2021-07-25","2021-07-25","2021-07-25"],"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":[["","65862020299","LOSARTAN POT","TAB 50MG","30","Select","Select",""],["","74312033511","BLACK COHOSH","CAP 540MG","540","Select","Select",""],["","58160089052","FLUARIX QUAD","INJ 2022-23","0","Select","Select",""],["","65862020299","LOSARTAN POTASSIUM","50 MG","90","Select","Select",""],["","65862020299","LOSARTAN POT TAB","50MG","30","Select","Select",""],["","74312033511","BLACK COHOSH CAP","540MG","540","Select","Select",""],["","58160089052","FLUARIX QUAD INJ","2022-23","0","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":""}]}]}