{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" N ALEGNANOTNROHT","gend":1,"add":"          ECALP SYDDAD 02                         ","city":"LEXINGTON                ","state":"VA","zip":"24450-9998","dob":"1986-01-10","age":"","mstatus":"","insh":"10114317","cliId":"","pno":"8704564754","cno":"","email":"","ename":"","eno":"","pphy":"CHILDERS, ROBERT S","ppno":5407728670,"pcpadd":"4035 ELECTRIC RD STE A,","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240188449,"pcpcounty":"","pcpid":"","pcpname":"VELOCITY CARE ROANOKE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"N","ano":"","add2":"                                                  ","add3":"","madd1":"20 DADDYS PLACE                                   ","madd2":"                                                  ","madd3":"","mcity":"LEXINGTON                ","mstate":"VA","mzip":"24450-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.81","M62.830","M54.2","M25.511","R06.02","K59.00","F32.9","F17.210","M62.838","G43.109","Z71.6","Z72.0","R13.10","Z00.00","F31.9","H57.11","S05.01XA","H20.041","R51.9","H53.149","R09.82","H04.201","R93.0","X58.XXXA","S05.01XD","D18.01","D22.9","Z80.8","R10.11","R11.2","Z01.419","E86.0","E87.6","F10.129","Z20.822","R05","J06.9","M79.662","M79.89","Z79.899","F10.120","Y90.3","R00.0","R52","M25.531"," ","H53.9"],"date":["2022-09-22","2021-04-04","2021-04-04","2021-04-04","2021-04-04","2021-04-04","2021-04-04","2022-07-30","2021-04-06","2021-07-13","2021-07-13","2022-03-17","2021-07-13","2021-08-25","2021-08-25","2021-09-02","2021-08-31","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-31","2021-08-31","2021-08-31","2021-09-02","2021-11-09","2021-11-09","2021-11-09","2022-01-21","2022-07-30","2022-04-19","2022-07-30","2022-07-30","2022-07-30","2022-07-30","2021-09-11","2021-09-11","2022-03-17","2022-03-17","2022-07-30","2022-07-30","2022-07-30","2022-07-30","2022-03-17","2022-06-08","2022-10-25","2022-10-25"],"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":[["","63402030430","LATUDA","TAB 40MG","30","Select","Select",""],["","65862021501","ZALEPLON","CAP 10MG","15.00","Select","Select",""],["","70436005901","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","13668000705","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","66993008269","SUMATRIPTAN","SPR 20MG\/ACT","12","Select","Select",""],["","13107008305","LORAZEPAM","TAB 0.5MG","30","Select","Select",""],["","69584061150","METHOCARBAM","TAB 500MG","12","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","31722054501","LITHIUM","CAP 300MG","60.00","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10.00","Select","Select",""],["","51991036278","RIZATRIPTAN","TAB 5MG ODT","30","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","59762371809","TRIAZOLAM","TAB 0.25MG","30","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","42571013725","KETOROLAC","SOL 0.005","5","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","3.5","Select","Select",""],["","65862084003","MOXIFLOXACIN","SOL HCL 0.5%","3","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":""}]}]}