{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" A ALUAPLLORRAC","gend":1,"add":"             RD AKNOT 901                         ","city":"FALLS MILLS              ","state":"VA","zip":"24613-9998","dob":"1976-07-31","age":"","mstatus":"","insh":"00119258","cliId":"","pno":"2367270266","cno":"","email":"","ename":"","eno":"","pphy":"REBKOVICH, KELLY N","ppno":2769888850,"pcpadd":"141 BEN BOLT AVE,","pcpcity":"Tazewell","pcpstate":"VA","pcpzip":246519700,"pcpcounty":"","pcpid":"","pcpname":"CARILION CLINIC FAMILY MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"109 TONKA DR                                      ","madd2":"                                                  ","madd3":"","mcity":"FALLS MILLS              ","mstate":"VA","mzip":"24613-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.41","E78.5","F78","E55.9","F79","H65.112","R09.81","R06.02","R30.0","F71","Z63.4","F43.21","F69","R03.0","Z79.899","R73.01","J30.9","F41.9","Z13.31","M26.09","E53.8","H65.113","Z13.1","H66.002","R42","E78.6","R35.0","I02.0","R07.89","R53.83","Z00.00","Z68.26","W57.XXXA","N64.4","B37.2","E61.1","Z12.31","Z12.39","Z12.11","M79.89","M25.571","M25.572","H61.23","R21","S69.92XA"," ","Z01.810","K57.30","Z23","K64.8","Z88.1","Z88.2"],"date":["2022-11-20","2022-10-03","2021-03-10","2022-10-03","2022-10-03","2021-06-22","2021-11-18","2022-07-12","2021-11-18","2022-07-20","2022-07-20","2022-09-20","2022-04-20","2021-11-18","2022-10-03","2022-04-20","2021-03-10","2021-03-10","2021-03-10","2021-04-27","2022-04-20","2021-04-27","2020-08-20","2020-03-18","2021-08-17","2020-02-13","2022-04-20","2019-12-30","2021-10-07","2019-11-14","2019-11-14","2021-03-10","2021-07-27","2021-08-17","2022-02-18","2022-04-20","2022-05-20","2022-04-20","2022-11-16","2022-06-07","2022-06-07","2022-06-07","2022-06-07","2022-10-03","2022-10-03","2022-11-20","2022-11-07","2022-11-16","2022-11-01","2022-11-16","2022-11-16","2022-11-16"],"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":[["","57237009960","CEFDINIR","CAP 300MG","20","Select","Select",""],["","16729004517","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","55111071830","LAMOTRIGINE","TAB 50MG ER","30","Select","Select",""],["","59762045001","COLESTIPOL","TAB 1GM","30","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00378827091","ALBUTEROL","NEB 0.00083","360","Select","Select",""],["","00713067831","NYSTATIN","CRE 100000","90.00","Select","Select",""],["","51672128202","TRIAMCINOLON","CRE 0.001","60","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","5","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","69315030802","CIPROFLOXACN","SOL 0.3% OP","2.5","Select","Select",""],["","70461032003","FLUCLVX","INJ 2020-21","0.5","Select","Select",""],["","62135098505","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","52268020101","SUTAB","TAB ","24","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":""}]}]}