{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AICIRTAPNOSLIW C","gend":1,"add":"WN DRAVELUOB DNALKAO 0244                         ","city":"ROANOKE                  ","state":"VA","zip":"24012-9998","dob":"1953-06-04","age":"","mstatus":"","insh":"10115704","cliId":"","pno":"1604592523","cno":5406137212,"email":"","ename":"","eno":"","pphy":"POLK, ELIZABETH L","ppno":5405625700,"pcpadd":"1314 PETERS CREEK RD,","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":240172500,"pcpcounty":"","pcpid":"","pcpname":"CARILION MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"4420 OAKLAND BOULEVARD NW                         ","madd2":"                                                  ","madd3":"","mcity":"ROANOKE                  ","mstate":"VA","mzip":"24012-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M51.36","M43.16","M54.16","M81.0","Z51.81","M47.816","Z12.31","Z01.818","E78.2","Z00.00","Z23","Z20.822","J44.9","L40.9","J45.909","E78.5","M80.00XA","L40.50","Z87.81","M54.5","I10","J41.0","G89.29","R91.1","M99.06","M99.03","M99.79","M99.01","M99.02","L85.3","M51.86","M51.84","M51.34","M79.671","M79.672","Z87.891","C50.411","Z17.1","D05.11","M25.461","Z51.0","C50.919","N64.89","M25.561","N63.13","N63.10","C77.3","M79.89","M19.90","J45.30","E78.00","I12.9","N18.2","E66.9","Z68.38","C50.911","Z13.79","Z17.0","N18.9","Z79.51","Z80.8"," ","S82.831A","S93.492A","M17.11","K26.5","M25.572","T14.90XA","Z68.37","D61.818","R00.0","R53.1","Z74.3","R10.9","K63.89","K57.30","Z51.11","K26.1","R11.2","Y92.239","D61.810","R65.10","E87.1","K52.1","E86.0","D63.0","B96.81","R05.9","R09.89","Z68.35","D72.829","R60.0","N39.0","R61","M62.81","Z03.89","M25.571","X50.1XXA","Y92.007","M89.9","M94.9","S82.401A","S82.402A"],"date":["2022-07-15","2022-07-15","2021-09-21","2022-08-19","2022-08-22","2022-07-15","2022-03-15","2022-06-07","2022-06-14","2022-01-07","2022-01-07","2022-10-16","2022-10-17","2022-08-22","2021-03-20","2021-03-20","2021-03-20","2021-03-20","2021-07-21","2021-09-17","2022-06-14","2022-06-07","2022-10-05","2021-07-19","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-08-18","2021-09-17","2021-09-17","2021-09-17","2021-09-19","2021-09-19","2022-07-19","2022-10-25","2022-10-25","2022-06-28","2022-07-14","2022-07-19","2022-10-26","2022-05-10","2022-09-08","2022-05-03","2022-06-29","2022-06-28","2022-10-28","2022-06-14","2022-06-14","2022-06-14","2022-10-16","2022-06-14","2022-10-16","2022-10-16","2022-06-28","2022-07-20","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-10-31","2022-10-31","2022-10-31","2022-10-05","2022-10-17","2022-10-28","2022-10-28","2022-08-09","2022-10-25","2022-10-17","2022-10-16","2022-10-16","2022-10-17","2022-10-17","2022-10-17","2022-10-13","2022-10-16","2022-10-16","2022-10-16","2022-10-16","2022-10-16","2022-10-16","2022-10-16","2022-10-16","2022-10-16","2022-10-16","2022-10-16","2022-10-16","2022-10-26","2022-10-17","2022-10-31","2022-10-16","2022-10-16","2022-10-16","2022-10-19","2022-10-28","2022-10-28","2022-10-28","2022-08-19","2022-08-19","2022-10-28","2022-10-28"],"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":[["","00173069600","ADVAIR","AER 250\/50","180","Select","Select",""],["","49281072010","FLUBLOK","INJ 2020-21","0.5","Select","Select",""],["","00074204202","SKYRIZI","INJ 150DOSE","1","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","00115180401","HYDROXYZ","CAP 50MG","90","Select","Select",""],["","59310057922","PROAIR","AER ","25.5","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","67877022305","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","20.10","Select","Select",""],["","68462029052","AUG","CRE 0.0005","50","Select","Select",""],["","93416173","AMOXICILLIN","SUS 400\/5ML","300","Select","Select",""],["","781602346","CLARITHROMYC","SUS 250\/5ML","300","Select","Select",""],["","378668910","PANTOPRAZOLE","TAB 40MG","11","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","53746074501","PROMETHAZINE","TAB 12.5MG","10","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","180","Select","Select",""],["","66993089715","BETA","OIN 0.0005","15","Select","Select",""],["","60432046400","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","20","Select","Select",""],["","54418425","DEXAMETHASON","TAB 4MG","40","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","20","Select","Select",""],["","49281012065","FLUZONE","INJ PF 20-21","0.7","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":""}]}]}