{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" D LATSYRCTEERTSREVO","gend":1,"add":"       EKIPNRUT MELAS 189                         ","city":"BEDFORD                  ","state":"VA","zip":"24523-1815","dob":"1967-04-17","age":"","mstatus":"","insh":"10119363","cliId":"","pno":"8504513903","cno":"","email":"","ename":"","eno":"","pphy":"THOMPSON, JAMES","ppno":5405684723,"pcpadd":"548 BLUE RIDGE AVE,  ","pcpcity":"Bedford","pcpstate":"VA","pcpzip":245232604,"pcpcounty":"","pcpid":"","pcpname":"CARILION CLINIC FAMILY MEDICINE BEDFORD RH","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"1599 CENTERVILLE ROAD                             ","madd2":"                                                  ","madd3":"","mcity":"BEDFORD                  ","mstate":"VA","mzip":"24523-1815","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M65.332","J30.1","J30.2","J30.81","Z23","E11.42","M54.9","Z79.4","Z79.899","M48.061","E78.2","I10","J30.89","R06.02","R06.2","J32.8","E11.9","M25.511","M19.90","F33.0","Z68.41","E11.3291","H40.033","H25.13","R09.81","M25.642","E11.65","N39.0","J01.10","H65.93","J01.90","R05","Z12.31","Z80.1","F41.9","F32.9","H92.01","B35.1","J32.9"],"date":["2022-03-16","2022-07-26","2022-07-26","2022-07-26","2021-12-17","2022-03-18","2022-06-15","2022-03-18","2022-03-18","2022-03-18","2022-03-18","2022-03-18","2022-01-11","2022-01-11","2022-01-11","2022-01-11","2022-06-15","2022-06-15","2020-09-17","2021-03-16","2020-09-17","2022-05-12","2022-05-12","2022-05-12","2020-09-09","2021-10-11","2021-10-11","2020-11-11","2020-06-17","2022-01-21","2021-08-02","2021-08-02","2020-12-11","2020-12-11","2020-10-20","2020-10-20","2022-01-05","2022-06-15","2021-07-13"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":[["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","68645057559","GLIPIZIDE","TAB 10MG","180","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","90","Select","Select",""],["","68645055254","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","00555088602","ESTRADIOL","TAB 1MG","90","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00093720110","PRAVASTATIN","TAB 20MG","90","Select","Select",""],["","00378803093","LANSOPRAZOLE","CAP 30MG DR","90","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","60","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","67877041301","METFORMIN","TAB 500MG ER","360","Select","Select",""],["","00597002402","COMBIVENT","AER 20-100","12","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","4","Select","Select",""],["","45802008801","ALBUTEROL","AER HFA","8.5","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","31722094301","HYDROCO\/APAP","TAB 10-325MG","120","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","65162067684","AZELASTINE","SPR 0.001","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","68645057154","CITALOPRAM","TAB 40MG","90","Select","Select",""],["","00555032302","HYDROXYZ","CAP 25MG","270","Select","Select",""],["","00143928501","AMOXICILLIN","TAB 875MG","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":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}