{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"R SIRODLHATS ","gend":1,"add":"EVONAH 4161WN EUNEVA R","city":"ROANOKE","state":"VA","zip":"24017-4024","dob":"1966-02-19","age":"","mstatus":"","insh":"00111453","cliId":"","pno":"9804577512","cno":"","email":"","ename":"","eno":"","pphy":"AUSTIN, ANN","ppno":"5402245170          ","pcpadd":"3 Riverside Cir, ","pcpcity":"3 Riverside Cir,","pcpstate":"VA","pcpzip":"240164955","pcpcounty":"","pcpid":"","pcpname":"CARILION CLINIC INTERNAL MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"APT B","add3":"","madd1":"1614 HANOVER AVENUE NW","madd2":"APT B","madd3":"","mcity":"ROANOKE","mstate":"VA","mzip":"24017-4024","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M51.16","M79.606","M79.89","G47.33","J44.9","Z72.0","G44.89","M26.629","R09.89","R39.81","L22","N39.46","K80.20","R16.0","F17.210","E66.01","Z68.43","M75.111","M25.511","S43.431A","M19.011","M77.9","M85.68","M25.411","Z23","R07.89","R06.02","M54.41","F41.9","J96.11","G89.29","M25.512","Z12.11","D12.3","Z86.010","J45.50","G47.30","K21.9","Z68.42","Z79.1","Z99.81","Z79.51","F32.9","G47.37","R73.09","R06.00","J45.20","M47.816","M62.830","Z01.818","M47.26","G47.36","J44.1","M25.78","I36.1","M54.42","J96.12","R10.11","K08.409","R36.9","M25.522","M19.042","N39.3","M54.16","R60.0","F17.200","Z72.821","M79.645","L60.2","L84","R42","L50.3","R06.09","Z11.1","R53.83","R63.5","M79.651","G57.11","Z01.812","Z12.31","G43.909","R00.2","M75.42","M70.22","L30.9","L29.9","F51.04","R55","F41.8","E53.8","Z99.89","I07.1","D21.9","R10.30","M47.896","M54.5","M25.48"],"date":["2021-05-04","2019-02-15","2019-12-18","2022-02-17","2022-01-18","2021-03-26","2018-05-16","2018-05-16","2018-05-16","2022-03-15","2022-03-15","2022-03-15","2020-07-31","2020-07-31","2021-01-08","2020-08-17","2020-08-17","2019-11-21","2020-11-25","2019-11-21","2019-11-21","2019-11-21","2019-11-21","2019-11-21","2020-11-25","2021-07-28","2021-07-28","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2020-11-25","2018-12-07","2018-12-07","2018-12-07","2020-02-26","2018-12-07","2020-02-26","2020-02-26","2018-12-07","2020-02-26","2018-12-07","2020-02-26","2020-07-08","2020-08-17","2021-07-28","2019-03-19","2021-05-04","2021-05-04","2021-01-03","2020-11-23","2019-12-17","2021-11-24","2020-08-17","2019-02-11","2020-09-28","2020-12-15","2020-08-17","2020-02-26","2020-02-26","2019-03-13","2019-03-13","2020-07-13","2020-07-13","2019-02-15","2022-02-17","2022-02-17","2019-03-13","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2019-05-03","2021-07-28","2019-08-16","2019-08-16","2020-08-17","2020-08-17","2020-10-24","2022-03-17","2018-11-07","2020-12-15","2020-01-03","2019-03-13","2019-02-01","2019-02-01","2019-02-01","2019-06-26","2019-05-17","2019-05-17","2019-05-17","2021-07-28","2019-08-16","2019-08-16","2020-11-05","2020-11-05","2020-11-05"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"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":[["","00378967130","IPRATROPIUM\/","SOL ALBUTER","360.00","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","25.50","Select","Select",""],["","00069046956","CHANTIX","TAB 1MG","140.00","Select","Select",""],["","69584061150","METHOCARBAM","TAB 500MG","90.00","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","180.00","Select","Select",""],["","00597002402","COMBIVENT","AER 20-100","4.00","Select","Select",""],["","00093742698","MONTELUKAST","TAB 10MG","90.00","Select","Select",""],["","00185012801","BUMETANIDE","TAB 0.5MG","180.00","Select","Select",""],["","60505384801","CELECOXIB","CAP 100MG","60.00","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","90.00","Select","Select",""],["","00006483703","PNEUMOVAX","INJ 25\/0.5","0.50","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12.00","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","90.00","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","180.00","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","90.00","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","100.00","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","90.00","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","10.00","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","14.00","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","60.00","Select","Select",""],["","59310057922","PROAIR","AER ","17.00","Select","Select",""],["","00143312601","DICYCLOMINE","CAP 10MG","360.00","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","90.00","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25.00","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","15.00","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","15.00","Select","Select",""],["","13668001105","CITALOPRAM","TAB 40MG","90.00","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","60.00","Select","Select",""],["","69097096507","NABUMETONE","TAB 500MG","60.00","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","0.50","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30.00","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}