{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DRAWOHNWORB ","gend":0,"add":"          WN TS HT53 4101                         ","city":"ROANOKE                  ","state":"VA","zip":"24017-9998","dob":"1952-03-28","age":"","mstatus":"","insh":"00118967","cliId":"","pno":"1931392168","cno":"","email":"","ename":"","eno":"","pphy":"MURCHISON, ROSS W","ppno":5402243870,"pcpadd":"615 MCDOWELL AVE NW,  STE 310","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240161225,"pcpcounty":"","pcpid":"","pcpname":"CARILION NORTHWEST INTERNAL MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"1014 35TH ST NW                                   ","madd2":"                                                  ","madd3":"","mcity":"ROANOKE                  ","mstate":"VA","mzip":"24017-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S09.90XA","W19.XXXA","Y93.9","Y92.9","Z53.21","J44.1","R06.02","J06.9","Z87.891","Z86.73","J44.9","J20.9","Z13.6","Z72.0","I69.354","I25.2","F41.9","K08.109","R03.0","Z82.3","Z82.5","Z91.81","N43.3","M89.49","N50.89","J44.0","Z23","R00.0","R05","Z00.00","Z79.899","Z12.11","H61.23","J02.9","B97.89","I51.7","R06.2","F17.210","E78.5","I10","I49.9","M19.93","Z99.89","F17.200","Z68.22","M25.512","M25.511","M25.552","M25.551","M62.81","M19.90","Z76.0","G89.29","M25.559","N44.2","I86.1","Z11.59","R04.0","I49.1","R09.3","Z20.828","Z87.09","R52","Z74.3"],"date":["2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-03-17","2020-12-28","2020-02-17","2020-02-17","2022-01-22","2022-08-04","2021-05-10","2020-09-09","2020-09-09","2020-07-17","2020-07-17","2020-07-17","2019-12-11","2020-09-16","2019-12-11","2019-12-11","2019-12-11","2020-08-18","2021-05-10","2020-08-18","2021-05-10","2020-09-16","2021-03-17","2021-03-17","2021-08-27","2021-08-27","2022-07-27","2022-07-27","2020-02-17","2020-02-17","2021-03-17","2019-08-06","2021-03-17","2022-01-22","2019-08-06","2020-07-17","2020-07-17","2020-07-17","2020-09-09","2020-07-17","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-01-07","2021-03-17","2021-03-17","2021-03-17","2020-08-18","2020-08-18","2021-02-04","2022-01-22","2020-02-17","2020-12-28","2020-12-28","2020-12-28","2021-11-15","2021-11-15"],"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":[["","00378827052","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","00603233832","APAP\/CODEINE","TAB 300-30MG","90","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","20","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10.2","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","00378967130","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","68180016106","AZITHROMYCIN","TAB 500MG","2","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":["",""]}},{"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":""}]}]}