{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARTHA A ALLEN","gend":1,"add":"7793 CONNER RD ","city":"COPPER HILL ","state":"VA","zip":"24079-9998","dob":"1950-08-21","age":"","mstatus":"","insh":11002429,"cliId":"8G64FH5EN94","pno":5406513159,"cno":5406513159,"email":"","ename":"","eno":"","pphy":"LLAVORE, JEREMY A ","ppno":5403345511,"pcpadd":"22890 Virgil H Goode Hwy","pcpcity":"Boones Mill ","pcpstate":"VA","pcpzip":240654989,"pcpcounty":"","pcpid":"P0117371","pcpname":"CARILION FAMILY AND INTERNAL MEDICINE BOONES MILL","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"7793 CONNER RD ","madd2":"","madd3":"","mcity":"COPPER HILL ","mstate":"VA","mzip":"24079-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["J06.9","E78.49","I10","J40","Z72.0","Z12.31","H25.13","H52.03","H52.4","Z00.00","R73.01","R74.8","R05","J01.00","E78.4","N39.0","E66.9","F43.21","G89.29","M15.0","Z68.32","Z79.891","Z80.3","Z82.3","Z82.49","Z83.3","Z88.5","Z88.8","H25.013","R73.03","E78.5","F51.01","Z79.899","Z23","H65.112","Z20.828","Z20.822","H25.813","H25.12","H25.11","R05.9"],"date":["2018-01-04","2020-02-10","2021-06-07","2020-02-10","2020-09-21","2020-11-19","2020-08-24","2021-09-10","2019-03-18","2020-09-21","2019-04-08","2020-10-01","2018-04-23","2018-06-28","2018-07-03","2018-07-03","2019-08-15","2019-08-15","2019-08-15","2020-12-21","2019-08-15","2019-08-15","2020-11-19","2019-08-15","2019-08-15","2019-08-15","2019-08-15","2019-08-15","2020-08-24","2020-10-01","2020-10-01","2020-12-21","2020-12-21","2020-10-01","2021-06-07","2021-08-06","2021-08-06","2021-09-30","2021-10-11","2021-10-14","2021-11-11"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null]}},{"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":[["","68180098003","LISINOPRIL","TAB 10MG","","Select","Select",""],["","10702001150","HYDROXYZ HCL","TAB 25MG","","Select","Select",""],["","378064110","PREDNISONE","TAB 10MG","","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","","Select","Select",""],["","93005805","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","33332031901","AFLURIA QUAD","INJ 2019-20","","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","13107008305","LORAZEPAM","TAB 0.5MG","","Select","Select",""],["","13107008305","LORAZEPAM ","TAB 0.5MG","30","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","50111043301","TRAZODONE ","TAB 50MG","60","Select","Select",""],["","10702001150","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","378064110","PREDNISONE ","TAB 10MG","18","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","93005805","TRAMADOL ","TAB 50MG","90","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","781185220","AMOX\/K ","875-125","14","Select","Select",""],["","33332031901","AFLURIA ","2019-20","0.5","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","10702001150","HYDROXYZ","25MG","30","Select","Select",""],["","00781185220","AMOX\/K","875-125","14","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","00093005805","TRAMADOL","50MG","90","Select","Select",""],["","33332031901","AFLURIA","2019-20","0.5","Select","Select",""],["","00065924007","DUREZOL","0.05%","5","Select","Select",""],["","24208044605","BESIVANCE","0.60%","5","Select","Select",""],["","24208044605","BESIVANCE ","SUS 0.006","5","Select","Select",""],["","00065924007","DUREZOL ","EMU 0.0005","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":[[["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":""}]}]}