{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHEILA A CROWDER","gend":1,"add":"6804 LEE HWY LOT 6","city":"RADFORD ","state":"VA","zip":"24141-9998","dob":"1956-01-28","age":"","mstatus":"","insh":11000176,"cliId":"9EA3EM1GM60","pno":5409945417,"cno":5405052924,"email":"","ename":"","eno":"","pphy":"HANNAH, CARL R","ppno":5403826148,"pcpadd":"6 Hickok St, ","pcpcity":"Christiansburg","pcpstate":"VA","pcpzip":240733524,"pcpcounty":"","pcpid":"P0060242","pcpname":"HCA CHRISTIANSBURG FAMILY MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"6804 LEE HWY LOT 6","madd2":"","madd3":"","mcity":"RADFORD ","mstate":"VA","mzip":"24141-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E53.8","E55.9","J44.9","E78.1","K21.9","J01.01","Z12.31","J18.1","F32.1","F41.3","R53.83","Z13.21","J44.1","R09.02","R06.02","H92.01","J96.01","Z72.0","J96.21","I50.30","F17.200","E78.5","F41.1","G43.909","F32.9","F10.10","Z79.899","F41.9","Z98.890","R60.0","R05","J32.9","R68.84","E71.120","R42","K04.7","M25.551","H53.9","M25.511","J34.89","T14.90XA","J40","H25.13"],"date":["2020-11-20","2020-11-20","2021-07-30","2020-04-09","2020-04-09","2021-07-30","2020-04-09","2019-05-29","2019-05-29","2019-05-29","2019-05-29","2019-05-29","2019-06-21","2019-06-17","2019-06-17","2019-06-17","2019-06-21","2019-06-21","2019-06-17","2019-06-17","2019-06-17","2019-06-17","2019-06-17","2019-06-17","2019-06-17","2019-06-17","2019-06-17","2019-06-17","2019-06-17","2019-06-18","2019-06-21","2020-08-07","2020-08-07","2019-08-21","2020-11-20","2020-11-20","2020-11-20","2021-07-30","2021-07-30","2021-07-30","2021-07-13","2021-07-13","2021-08-24"],"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[["","62175061743","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","173069600","ADVAIR DISKU","AER 250\/50","","Select","Select",""],["","378699152","ALBUTEROL","NEB 0.63MG\/3","","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","66689000802","NYSTATIN","SUS 100000","","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E HFA INH","","Select","Select",""],["","597010061","SPIRIVA","SPR 2.5MCG","","Select","Select",""],["","597015561","STIOLTO","AER 2.5-2.5","","Select","Select",""],["","65862053750","LEVOFLOXACIN","TAB 500MG","","Select","Select",""],["","173086910","ANORO ELLIPT","AER 62.5-25","","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","597015561","STIOLTO ","AER 2.5-2.5","4","Select","Select",""],["","378699152","ALBUTEROL ","NEB 0.63MG\/3","375","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","66689000802","NYSTATIN ","SUS 100000","112","Select","Select",""],["","597010061","SPIRIVA ","SPR 2.5MCG","4","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","5","Select","Select",""],["","173086910","ANORO ","62.5-25","60","Select","Select",""],["","68180016006","AZITHROMYCIN ","250MG","6","Select","Select",""],["","69097052444","DICLOFENAC ","0.01","100","Select","Select",""],["","69097052444","DICLOFENAC","0.01","100","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","68180016006","AZITHROMYCIN","250MG","6","Select","Select",""],["","00173086910","ANORO","62.5-25","60","Select","Select",""],["","00093101042","MUPIROCIN","0.02","22","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","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":""}]}]}