{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ENNAZUSSNIKTA ","gend":1,"add":"     WS EVIRD  DNALREVO   7381                              ","city":"ROANOKE                       ","state":"VA","zip":"24018-1535","dob":"1953-12-19","age":"","mstatus":"","insh":"50011043","cliId":"","pno":"9804594632","cno":5406762668,"email":"","ename":"","eno":"","pphy":"EPLING, JOHN WILSON                                         ","ppno":"","pcpadd":"1314 PETERS CREEK ROAD,SUITE 10","pcpcity":"ROANOKE                       ","pcpstate":"VA","pcpzip":240172500,"pcpcounty":"","pcpid":"P0117344","pcpname":"CARILION FAMILY MEDICINE ROANOKE SALEM","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1837   OVERLAND  DRIVE SW                                   ","madd2":"                                                            ","madd3":"","mcity":"ROANOKE                       ","mstate":"VA","mzip":"24018-1535","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J01.90","J22","M72.2","M20.41","M20.42","M79.674","M79.675","E11.42","I87.2","L60.0","N30.01","F43.21","N39.0","R10.30","R11.2","E78.5","E11.9","I10","J45.909","E66.9","Z79.51","Z79.84","Z68.38","J45.40","F43.10","M25.572","R29.6","S82.65XA","S82.845A","W10.9XXA","Y92.009","F17.200","M79.609","S82.302A","S82.832A","X58.XXXA","M79.605","Z68.34","R26.2","R68.89","S82.842A","M79.671","M79.672","M62.81","S82.845D","M51.36","R05","B37.0","J30.2","N89.8","R11.0","J20.9","M79.2","R30.0","Z23","B35.1"],"date":["2019-01-14","2019-01-14","2020-12-01","2020-09-01","2020-09-01","2021-03-02","2021-03-02","2021-09-15","2020-06-02","2021-03-02","2019-05-30","2019-05-30","2020-12-26","2019-07-22","2019-07-22","2019-12-01","2020-04-28","2021-09-29","2021-09-29","2019-12-01","2019-09-05","2019-09-05","2019-07-22","2020-04-28","2020-04-28","2019-09-12","2019-09-01","2019-09-01","2019-09-01","2019-09-01","2019-09-01","2019-09-01","2019-09-05","2019-09-05","2019-09-05","2019-09-05","2019-09-05","2019-09-05","2020-01-21","2019-10-03","2019-10-03","2021-09-15","2021-09-15","2019-11-23","2019-12-01","2019-12-01","2020-02-24","2020-02-24","2020-04-28","2020-04-28","2020-06-23","2020-10-17","2021-03-02","2020-12-26","2020-12-26","2021-03-02"],"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":[["","00378932132","WIXELA","250\/50","60","Select","Select",""],["","68382076010","METFORMIN","1000MG","60","Select","Select",""],["","68180055409","QUINAPRIL","40MG","60","Select","Select",""],["","68180072103","AMLODIPINE","10MG","30","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","23155000810","HYDROCHLOROT","25MG","30","Select","Select",""],["","00093727298","PIOGLITAZONE","30MG","30","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","69097094312","GABAPENTIN","300MG","120","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","80777027399","MODERNA","COVID-19","0.5","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00378797052","IPRATROPIUM","0.02%INH","62.5","Select","Select",""],["","67877057305","BENZONATATE","100MG","30","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","00378064110","PREDNISONE","10MG","18","Select","Select",""],["","66689000816","NYSTATIN","100000","140","Select","Select",""],["","59779045839","CVS","10MG","30","Select","Select",""],["","65162052110","PROMETHAZINE","25MG","12","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","120","Select","Select",""],["","00378932132","WIXELA ","AER 250\/50","60","Select","Select",""],["","68382076010","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","68180055409","QUINAPRIL ","TAB 40MG","60","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","23155000810","HYDROCHLOROT ","TAB 25MG","30","Select","Select",""],["","00093727298","PIOGLITAZONE ","TAB 30MG","30","Select","Select",""],["","00173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00378797052","IPRATROPIUM ","SOL 0.02%INH","62.5","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","18","Select","Select",""],["","66689000816","NYSTATIN ","SUS 100000","140","Select","Select",""],["","59779045839","CVS ","TAB 10MG","30","Select","Select",""],["","65162052110","PROMETHAZINE ","TAB 25MG","12","Select","Select",""],["","00093742698","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","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","",""],["Yes","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":""}]}]}