{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RHONDA   S CONNER","gend":1,"add":"1128   GOODVIEW ROAD                                        ","city":"GOODVIEW                      ","state":"VA","zip":"24095-3349","dob":"1968-06-06","age":"","mstatus":"","insh":4285932,"cliId":"","pno":5406762806,"cno":5403555581,"email":"","ename":"","eno":"","pphy":"EPLING, JOHN WILSON                                         ","ppno":5405625700,"pcpadd":"1314 PETERS CREEK ROAD                                      ,                                                            ","pcpcity":"ROANOKE                       ","pcpstate":"VA","pcpzip":240172500,"pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY MEDICINE SOUTHEAST FAMILY MEDICAL","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"1128   GOODVIEW ROAD                                        ","add3":"","madd1":"1128   GOODVIEW ROAD                                        ","madd2":"APT C                                                       ","madd3":"","mcity":"GOODVIEW                      ","mstate":"VA","mzip":"24095-3349","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","F43.23","J43.1","I25.10","Z72.0","N39.41","R32","Z48.812","Z95.828","I77.1","H53.8","H53.9","G45.9","I65.23","Z95.5","Z71.6","E78.5","I73.9","I65.21","T82.855D","Z98.890","I65.9","I65.22","I25.2","Z79.02","J44.9","G47.30","K21.9","Z86.73","F17.210","Z23","Z01.810","Z01.818","M43.6","R07.9","J43.9","M54.16","B37.0","M79.605","I70.202","R35.0","M54.10","M79.18","I95.0","I70.212","I70.91","M25.552","Z98.61","Z56.0","R52","M54.42","Z01.812","I70.8","G89.29","M54.5","Z79.82","Z79.899","M25.562","Z09","M22.8X2","M25.80","E65","R91.1","L30.9","E88.89","R91.8","I70.90","R22.32","M25.512","D12.6","R29.898","T82.856A","Z86.79","J06.9"],"date":["2021-07-22","2020-05-07","2021-04-08","2022-03-17","2021-04-08","2020-05-07","2020-05-14","2020-05-27","2021-09-10","2021-07-22","2020-06-16","2020-06-16","2020-06-16","2021-01-14","2021-01-04","2020-11-23","2021-07-09","2021-07-22","2022-05-27","2020-12-15","2022-05-27","2021-01-04","2021-07-22","2021-01-04","2021-07-22","2021-08-12","2021-01-04","2021-07-22","2021-07-09","2021-08-12","2022-03-17","2020-12-23","2020-12-29","2021-04-08","2021-04-21","2021-10-27","2021-05-27","2021-07-01","2022-03-17","2021-06-17","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-22","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-07-14","2021-07-19","2021-07-22","2022-04-27","2021-07-22","2021-07-22","2021-07-22","2021-08-16","2022-05-27","2021-09-01","2021-09-01","2021-09-01","2021-10-27","2022-03-17","2021-09-15","2021-10-27","2021-10-27","2022-03-22","2022-04-27","2022-04-27","2022-05-06","2022-05-27","2022-05-27","2022-06-16"],"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":[["","","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","","SEREVENT","AER 50MCG","60","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","3","Select","Select",""],["","00093206406","CILOSTAZOL","TAB 100MG","60","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","60","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","00173069500","ADVAIR","AER 100\/50","180","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","00115180301","HYDROXYZ","CAP 25MG","50","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","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":""}]}]}