{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ALUAPSITRUC L","gend":1,"add":" EOLYAT 10211 TOL ES EVA","city":"ROANOKE","state":"VA","zip":"24013-9998","dob":"1975-08-11","age":"","mstatus":"","insh":"3635110*57","cliId":"","pno":"95\/0458638-0","cno":"540\/590-8368","email":"","ename":"","eno":"","pphy":"YOUNG, DEANA ANN MD","ppno":"540\/387-0441","pcpadd":"1935 W MAIN ST","pcpcity":"SALEM","pcpstate":"VA","pcpzip":24153,"pcpcounty":"","pcpid":"","pcpname":"Carilion Clinic Primary Care Associates Salem","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","F31.9","E11.42","E11.8","R25.2","E55.9","Z79.899","Z79.4","E11.9","F43.21","F31.81","F29.","F51.05","F99.","R50.9","R05.","N76.4","G56.02","M70.61","E11.65","M70.62","J06.9","R00.0","Z20.828","F17.210","F17.290","M54.5","F41.9","M54.30","F17.200","Z00.8","Z13.89","Z13.9","S29.012A","M54.6","E78.5","Z68.41","N92.0","I49.9"],"date":["2021-09-28","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-12-15","2021-07-16","2020-08-24","2021-09-28","2021-09-28","2021-11-26","2021-11-26","2021-11-26","2021-11-26","2020-03-18","2020-03-18","2020-03-10","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-03-18","2020-03-18","2020-03-18","2020-03-18","2020-03-18","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2022-11-22","2022-11-22","2020-02-05","2020-02-05","2020-02-05","2020-09-09"],"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":[["","00597015330","JARDIANCE","TAB 25MG","30","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","50","Select","Select",""],["","64980028101","GLIPIZIDE","TAB 10MG","180","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","72189003430","PREGABALIN","CAP 150MG","30","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","66993037179","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","15","Select","Select",""],["","59779044101","SLEEP-AID","TAB 25MG","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","67877043203","ARIPIPRAZOLE","TAB 10MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","80777027315","MODERNA","INJ COVID-19","0","Select","Select",""],["","11917014868","MELATONIN","TAB 3MG","60","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","10","Select","Select",""],["","65862070460","ZIPRASIDONE","CAP 60MG","60","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","200","Select","Select",""],["","75834002001","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","70461032003","FLUCLVX","INJ 2020-21","0","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}