{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROGER L FISHER","gend":0,"add":"2001 HAWKINS LANE ","city":"NEW CASTLE  ","state":"VA","zip":"24127-9998","dob":"1983-06-23","age":"","mstatus":"","insh":11001333,"cliId":"5DF9CY1AR26","pno":5408645276,"cno":5408645276,"email":"","ename":"","eno":"","pphy":"SAKS, JONATHAN C  ","ppno":5408282634,"pcpadd":"282 Westlake Rd","pcpcity":"Hardy ","pcpstate":"VA","pcpzip":241013967,"pcpcounty":"","pcpid":"P0117411","pcpname":"CARILION INTERNAL MEDICINE WESTLAKE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2001 HAWKINS LANE ","madd2":"","madd3":"","mcity":"NEW CASTLE  ","mstate":"VA","mzip":"24127-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E03.9","J30.1","J45.40","R73.09","R51","I10","K29.40","Z23","J45.51","M54.2","J45.41","Z76.0","J30.89","R06.02","H43.813","H16.143","H52.11","H52.223","R20.2","Z00.00","Z13.220","E11.9","J45.20","J45.30","E07.89","R76.8","T78.49XA","T15.01XD","T15.02XA","T15.01XS","E06.3","R10.31","Z79.51","Z79.899","R10.819","Z99.89","M79.18","R06.2","J45.50","Z91.09","K31.9","K44.9","J45.909","Z79.84","Z79.1","K29.50","K29.70"],"date":["2020-08-04","2018-05-09","2020-01-21","2020-01-21","2020-09-14","2020-09-14","2020-01-21","2020-09-14","2020-02-13","2020-06-02","2018-10-02","2018-10-02","2020-06-02","2019-06-19","2018-05-09","2018-05-09","2018-05-09","2018-05-09","2019-05-22","2019-05-22","2020-06-02","2020-09-14","2020-09-14","2018-06-13","2019-06-19","2019-06-19","2019-06-19","2018-08-03","2018-08-02","2018-08-03","2020-08-04","2019-08-27","2019-08-27","2019-12-19","2019-08-26","2019-08-26","2019-09-12","2020-09-14","2019-12-20","2019-09-25","2019-12-19","2019-12-19","2019-12-19","2019-12-19","2019-12-19","2019-12-19","2019-12-19"],"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":[["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","16714044702","AMITRIPTYLIN","TAB 25MG","","Select","Select",""],["","31722055190","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","185061505","HYDROXYZ PAM","CAP 50MG","","Select","Select",""],["","378180310","LEVOTHYROXIN","TAB 50MCG","","Select","Select",""],["","173071720","ADVAIR HFA","AER 230\/21","","Select","Select",""],["","65162018810","NAPROXEN","TAB 250MG","","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","","Select","Select",""],["","43547041711","LISINOPRIL","TAB 20MG","","Select","Select",""],["","597010061","SPIRIVA","SPR 2.5MCG","","Select","Select",""],["","57664037713","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","65862000899","METFORMIN","TAB 500MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","57664050318","TIZANIDINE","TAB 4MG","","Select","Select",""],["","93220305","METOCLOPRAM","TAB 10MG","","Select","Select",""],["","45802008801","ALBUTEROL","AER HFA","","Select","Select",""],["","43547041711","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","23155010310","METFORMIN ","TAB 850MG","60","Select","Select",""],["","31722055190","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","597010061","SPIRIVA ","SPR 2.5MCG","4","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","45802008801","ALBUTEROL ","AER HFA","8.5","Select","Select",""],["","16714044702","AMITRIPTYLIN ","TAB 25MG","30","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","173071720","ADVAIR ","AER 230\/21","12","Select","Select",""],["","185061505","HYDROXYZ ","CAP 50MG","120","Select","Select",""],["","57664037713","TRAMADOL ","TAB 50MG","28","Select","Select",""],["","43547040011","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","527134601","LEVOTHYROXIN ","TAB 112MCG","30","Select","Select",""],["","65162018810","NAPROXEN ","TAB 250MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","49502010202","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","57664050318","TIZANIDINE ","TAB 4MG","42","Select","Select",""],["","93220305","METOCLOPRAM ","TAB 10MG","20","Select","Select",""],["","00173071720","ADVAIR","230\/21","12","Select","Select",""],["","00185061505","HYDROXYZ","50MG","120","Select","Select",""],["","57664037713","TRAMADOL","50MG","28","Select","Select",""],["","59310057922","PROAIR","","8.5","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","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}