{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L V LEUMASRS SOREDNA","gend":0,"add":"       EVA EESSENNET 4224                         ","city":"ROANOKE                  ","state":"VA","zip":"24017-9998","dob":"1954-05-17","age":"","mstatus":"","insh":"00114477","cliId":"","pno":"0204552884","cno":"","email":"","ename":"","eno":"","pphy":"AUSTIN, ANN","ppno":5402245170,"pcpadd":"3 RIVERSIDE CIR,","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240164955,"pcpcounty":"","pcpid":"","pcpname":"CARILION CLINIC INTERNAL MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"4224 TENNESSEE AVE                                ","madd2":"                                                  ","madd3":"","mcity":"ROANOKE                  ","mstate":"VA","mzip":"24017-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.2","E11.69","I10","Z86.73","E55.9","I63.9","E11.9","E11.65","E78.5","D72.829","E78.1","R10.9","R41.0","R42","R74.8","Z87.891","R10.32","N17.9","R91.1","J16.8","J18.9","R05","Z79.4","Z79.82","R50.9","R00.0","Z20.828","R06.02","M79.10","E11.8","Z12.11","N52.9","R91.8","Z09","Z87.09","J98.4","I25.10","Z23","E88.81","H53.8"," "],"date":["2022-04-29","2022-06-17","2022-05-27","2021-11-30","2021-06-16","2021-07-30","2022-09-26","2020-11-24","2020-06-29","2020-11-24","2020-06-29","2019-07-04","2019-07-04","2019-07-04","2019-07-04","2020-08-03","2019-07-04","2019-07-09","2019-09-27","2020-08-03","2020-09-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2019-09-12","2019-09-17","2022-06-03","2021-09-17","2019-09-25","2019-09-25","2019-09-25","2019-09-25","2019-09-25","2021-11-30","2022-08-12","2022-08-12","2022-09-26"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"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":[["","65862029490","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","16729000316","GLIMEPIRIDE","TAB 4MG","180","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","90","Select","Select",""],["","65862001005","METFORMIN","TAB 1000MG","180","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","56151172301","INSULIN","MIS 1ML\/30G","100","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","300","Select","Select",""],["","00378395305","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","3","Select","Select",""],["","08222720031","GNP","MIS 32GX5\/32","100","Select","Select",""],["","73070020315","INS","INJ FLEXPEN","15","Select","Select",""],["","00169430730","RYBELSUS","TAB 7MG","30","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","56151014401","TRUPLUS","MIS 30G","300","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","18","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","00169369619","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","33342002208","LEVOFLOXACIN","TAB 500MG","10","Select","Select",""],["","08554333702","AGAMATRIX","TES PRESTO","100","Select","Select",""],["","38396031618","LANCET","MIS THIN 33G","100","Select","Select",""],["","00193658621","MICROLET","MIS LANCETS","300","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}