{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ARDNASSACSGNINNEJ L","gend":1,"add":"     WS EVA REVOTSEW 6242                         ","city":"ROANOKE                  ","state":"VA","zip":"24015-9998","dob":"1990-01-27","age":"","mstatus":"","insh":"10110504","cliId":"","pno":"1904556855","cno":"","email":"","ename":"","eno":"","pphy":"PEEVEY, RUTH E","ppno":5402651607,"pcpadd":"4910 VALLEY VIEW BLVD,","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24012,"pcpcounty":"","pcpid":"","pcpname":"LEWIS GALE PHYSICIANS LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"2426 WESTOVER AVE SW                              ","madd2":"                                                  ","madd3":"","mcity":"ROANOKE                  ","mstate":"VA","mzip":"24015-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F60.3","F42.8","F43.10","F34.1","F41.0","X83.8XXA","R00.0","I15.8","F60.7","F25.1","I10","R63.5","M51.36","E66.9","F33.2","R42","R20.2","R53.1","E78.5","F32.9","F41.9","R20.0","M25.552","M25.551","M79.605","F31.30","F41.1","Z72.89","S31.119A","M54.32","M25.561","M25.562","M54.5","F32.3","Z91.5","G47.10","G47.33","Z79.899","F40.00","M54.42","G89.29","Z86.59","E66.3","G89.4","R45.851","M54.16","M51.37","M51.26","M48.061","M51.27","M48.07","F40.01","F40.11","M70.61","M70.62","K21.9","D31.92","H10.45","H52.13","H52.223","K62.5","R06.83"," ","R06.81","R40.0","R10.11","R73.09"],"date":["2022-12-07","2022-10-06","2022-10-06","2022-10-06","2021-06-17","2022-10-06","2021-11-11","2021-09-13","2022-10-06","2021-04-25","2022-11-15","2021-04-12","2022-11-15","2021-04-12","2020-07-01","2020-06-08","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2020-06-08","2020-06-08","2021-07-12","2020-08-13","2020-11-18","2022-11-15","2022-03-30","2020-06-24","2020-06-24","2020-06-24","2021-07-12","2022-11-23","2020-08-13","2021-08-23","2021-08-23","2022-08-08","2020-11-18","2020-12-16","2020-10-06","2020-11-18","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2020-12-16","2020-12-16","2020-12-16","2020-12-16","2020-12-16","2020-12-21","2020-12-28","2021-01-11","2021-01-11","2022-11-15","2022-03-04","2022-03-04","2022-03-04","2022-03-04","2022-07-12","2022-11-21","2022-12-07","2022-11-21","2022-11-21","2022-11-15","2022-11-15"],"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":[["","65862069705","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","60505009500","DOXAZOSIN","TAB 4MG","7","Select","Select",""],["","00603548232","PROPRANOLOL","TAB 10MG","5.00","Select","Select",""],["","00406117003","NALTREXONE","TAB 50MG","7","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","14","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","7","Select","Select",""],["","45802016000","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00228282011","HYDROCHLOROT","TAB 12.5MG","10","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","7","Select","Select",""],["","55111046705","METOPROL","TAB 50MG ER","7","Select","Select",""],["","55111053301","DIVALPROEX","TAB 250MG ER","7","Select","Select",""],["","42806066401","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","68382000810","LAMOTRIGINE","TAB 100MG","7","Select","Select",""],["","64764073030","TRINTELLIX","TAB 10MG","14","Select","Select",""],["","62332000131","FAMOTIDINE","TAB 20MG","7","Select","Select",""],["","16729032110","OLMESA","TAB 20MG","7.00","Select","Select",""],["","19515080852","FLULAVAL","INJ 2022-23","0.5","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0.30","Select","Select",""],["","65702040810","ACCU-CHEK","TES AVIVA PL","100","Select","Select",""],["","50924097110","SOFTCLIX","MIS LANCETS","100","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":""}]}]}