{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"E ELLERIATLEFREVO ","gend":1,"add":"NOOB4817LIART SE","city":"BOONES MILL","state":"VA","zip":"24065-4406","dob":"1990-12-12","age":"","mstatus":"","insh":"4508172","cliId":"","pno":"8504551558","cno":"","email":"","ename":"","eno":"","pphy":"KEILMAN, DAVID A","ppno":5407253060,"pcpadd":"5303 INDIAN GRAVE RD,","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":"24018-9107","pcpcounty":"","pcpid":"","pcpname":"LEWIS GALE PHYSICIANS LLC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"7184BOONES TRAIL","add3":"","madd1":"7184BOONES TRAIL","madd2":"APARTMENT L","madd3":"","mcity":"BOONES MILL","mstate":"VA","mzip":"24065-4406","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N91.2","N93.9","J06.9","M79.10","J02.9","J45.909","Z20.822","R05","B34.9","B97.89","R05.1","R09.81","R50.9","R05.9","F17.200","U07.1","J02.0","Z79.890","Z79.899","R11.2","F11.20","S00.83XA","R07.81","W01.10XA","W18.30XA","S09.93XA","J34.2","S29.9XXA","A41.9","L03.113","L03.114","L02.413","I82.622","F11.23","D63.8","D72.819","E03.9","E16.2","F31.9","G43.909","Z91.14","B96.89","J85.3","D64.9","F41.9","R74.01","L03.90","R22.32","M79.601","R00.0","A49.8","F11.10","F19.90","F41.8","I07.1","I38","A41.50","M79.89","L53.9","I82.612","L02.414","L02.415","R70.0","R79.82","L03.115","F90.0","F13.10","R07.9","F11.93"],"date":["2021-03-22","2021-03-22","2022-01-29","2021-08-20","2022-04-21","2022-04-21","2023-04-22","2021-09-22","2021-09-22","2021-09-22","2021-10-11","2021-10-11","2022-11-18","2021-10-11","2021-10-11","2022-01-29","2022-04-21","2022-12-19","2022-12-19","2022-04-21","2023-04-22","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2022-11-16","2022-11-24","2022-11-16","2022-11-16","2022-12-01","2022-11-16","2022-11-16","2022-11-16","2022-11-16","2022-11-16","2022-11-16","2022-11-24","2022-11-16","2022-11-16","2022-11-16","2022-11-24","2022-11-16","2022-11-24","2022-11-16","2022-11-16","2022-11-28","2023-04-22","2022-11-22","2023-03-30","2022-11-22","2022-11-22","2022-11-24","2022-11-24","2022-11-24","2022-11-28","2022-11-28","2022-12-01","2022-12-19","2022-12-19","2022-12-19","2022-12-19","2022-12-19","2023-03-30","2023-04-22","2023-04-22","2023-04-23"],"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":[["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","64380071307","BENZONATATE","CAP 200MG","21","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","6.7","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","40","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","30","Select","Select",""],["","00536100901","FERROUS SULF","TAB 325MG","15","Select","Select",""],["","16571041305","CIPROFLOXACN","TAB 750MG","17","Select","Select",""],["","49483070210","FLUOXETINE","CAP 20MG","30","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":[]}},{"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":""}]}]}