{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" HALEKHARSREGOR M","gend":1,"add":"         EVA ADIROLF 8042                         ","city":"ROANOKE                  ","state":"VA","zip":"24017-9998","dob":"1982-12-14","age":"","mstatus":"","insh":"00119959","cliId":"","pno":"1804547429","cno":"","email":"","ename":"","eno":"","pphy":"KEILMAN, DAVID A","ppno":5402651607,"pcpadd":"4910 VALLEY VIEW BLVD NW,  ","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240122022,"pcpcounty":"","pcpid":"","pcpname":"LEWIS GALE PHYSICIANS LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"2408 FLORIDA AVE                                  ","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":["S13.9XXA","M54.2","V89.2XXA","Y92.410","F17.200","R55","R11.2","M54.9","V49.40XA","J45.909","F32.9","F41.9","F25.9","Z79.51","M54.5","L20.84","M77.41","L11.0","L85.1","L84","M54.42","V43.52XA","K21.9","D72.829","E66.9","R06.02","J10.89","Z72.0","Z74.3","L30.9","S40.811A","Y93.I9","S80.212A","S00.411A","F17.210","Z23","T14.90XA","J30.2","Z02.89","I10","F25.0","F41.1","M77.42","M20.41","M20.42","B35.3","B35.1","M79.672","M79.671","H61.23","E86.0","K29.00","K59.00","K92.1","Z79.1","L60.0","M25.562","R03.0","N39.0","X50.0XXA","Z68.32","Z79.899","F25.8","G47.00","F43.12","Z51.81","K29.70","R10.9","R11.0","F31.9","F40.10","S39.012D","J10.1","R50.9","R42","V89.2XXD","L57.0","R06.2","J06.9","R05","Z68.33"],"date":["2022-07-02","2022-07-19","2022-07-02","2022-07-02","2022-07-19","2021-11-19","2021-11-19","2021-03-12","2020-07-29","2022-07-19","2020-07-29","2020-07-29","2021-11-29","2022-07-19","2021-03-12","2020-12-15","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2020-10-01","2020-07-14","2022-02-18","2021-09-03","2022-02-18","2020-02-10","2020-02-10","2021-10-14","2021-11-19","2020-08-10","2020-07-10","2020-07-10","2020-07-10","2020-07-10","2020-09-18","2020-09-30","2020-07-10","2022-02-18","2020-08-12","2021-11-19","2021-07-20","2021-11-29","2022-02-07","2022-02-07","2022-02-07","2020-07-13","2021-02-01","2020-01-07","2020-01-07","2020-09-30","2021-08-08","2021-08-08","2021-08-08","2021-10-14","2021-10-14","2021-02-01","2020-07-10","2020-05-13","2021-03-19","2021-03-12","2021-03-12","2022-05-06","2020-01-08","2022-07-28","2020-06-26","2020-06-26","2021-08-08","2021-08-08","2022-02-18","2022-07-28","2022-07-28","2021-03-19","2020-02-10","2020-02-10","2021-11-19","2020-07-17","2020-10-12","2020-02-10","2021-05-12","2021-05-12","2022-05-06"],"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":[["","65862067899","ALPRAZOLAM","TAB 1MG","60","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","17","Select","Select",""],["","14539067401","HYDROXYZ","CAP 25MG","30","Select","Select",""],["","68180071909","AMLODIPINE","TAB 2.5MG","90","Select","Select",""],["","68180095603","CLOBETASOL","CRE 0.0005","90","Select","Select",""],["","13668001105","CITALOPRAM","TAB 40MG","30","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","65862049460","QUETIAPINE","TAB 300MG","90","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","90","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","90","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","16729020201","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","00186091612","PULMICORT","INH 180MCG","3","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","12","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","10","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","71093014105","METHOCARBAM","TAB 750MG","9","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","51991083801","CYPROHEPTAD","TAB 4MG","270","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","20","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":""}]}]}