{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EH F   NHOJRJ NOSREDN","gend":0,"add":" OCCABOT 081EVIRD SDLEIF","city":"MARTINSVILLE","state":"VA","zip":"24112-8906","dob":"1968-06-12","age":"","mstatus":"","insh":"3864483","cliId":"","pno":"3204504988","cno":5402388940,"email":"","ename":"","eno":"","pphy":"ATIENZA, VERGEL S","ppno":5404844800,"pcpadd":"390 S Main St Ste 201, ","pcpcity":"Rocky Mount","pcpstate":"VA","pcpzip":241511767,"pcpcounty":"","pcpid":"","pcpname":"CARILION MEDICAL ASSOCIATES FE","ano":"","add2":"APARTMENT 17","add3":"","madd1":"180 TOBACCO FIELDS DRIVE","madd2":"APARTMENT 17","madd3":"","mcity":"MARTINSVILLE","mstate":"VA","mzip":"24112-8906","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R22.41","R60.0","I96","J44.9","S81.801A","L02.415","L03.115","E11.22","I12.9","N18.3","B19.20","K70.31","F10.10","Z79.4","E11.21","E78.2","S81.801D","M79.89","I10","D69.59","N17.9","E87.1","E83.42","E87.2","B18.2","I87.8","M79.604","R11.2","R06.6","R18.8","I86.8","R16.1","T81.89XA","N18.30","A41.9","R65.20","E87.6","D69.6","K70.30","R00.1","I49.1","I51.7","R94.31","K74.60","F10.20","S81.851A","E11.9","Z20.828","I45.10","K74.69"],"date":["2020-09-16","2021-03-09","2020-09-18","2020-09-18","2020-09-21","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-09-28","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-01","2020-09-28","2020-12-01","2020-09-18","2020-09-14","2020-09-16","2020-09-21","2020-09-21","2020-09-21","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-09-21","2020-09-16","2020-09-16","2020-10-21","2020-12-04","2020-09-16","2020-09-16","2020-09-21","2020-09-21","2020-05-12","2020-09-19","2020-09-19","2020-09-19","2020-09-19","2020-09-21","2020-09-21","2020-09-16","2020-09-16","2021-01-09","2020-09-19","2021-03-09"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68462019605","PRAVASTATIN ","TAB 20MG","30","Select","Select",""],["","42799012101","BUMETANIDE ","TAB 2MG","60","Select","Select",""],["","00093220401","METOCLOPRAM ","TAB 5MG","20","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","30","Select","Select",""],["","31722052110","HYDRALAZINE ","TAB 50MG","90","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","00185005501","METOLAZONE ","TAB 5MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","00169643810","LEVEMIR ","INJ FLEXTOUC","6","Select","Select",""],["","00536104710","SODIUM ","TAB 650MG","58","Select","Select",""],["","08396900218","PEN  NEEDLES  ","MIS 31GX8MM","100","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","68382009405","CARVEDILOL ","TAB 12.5MG","60","Select","Select",""],["","42571025101","CLINDAMYCIN ","CAP 150MG","48","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","20","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}