{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESA M MADERA","gend":1,"add":"4878 MEWS HILL DR ","city":"ROANOKE  ","state":"VA","zip":"24018-9998","dob":"1978-12-12","age":"","mstatus":"","insh":11003582,"cliId":"5YT9D98UU57","pno":5406825364,"cno":5407592388,"email":"","ename":"","eno":"","pphy":"SWEET, MARY G  ","ppno":5405625700,"pcpadd":"1314 Peters Creek Rd Nw Ste 14","pcpcity":"Roanoke  ","pcpstate":"VA","pcpzip":240172500,"pcpcounty":"","pcpid":"P0117344","pcpname":"CARILION FAMILY MEDICINE ROANOKE SALEM","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"4878 MEWS HILL DR ","madd2":"","madd3":"","mcity":"ROANOKE  ","mstate":"VA","mzip":"24018-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["N20.0","R10.30","N39.0","R10.9","R19.7","F17.200","Z86.73","R10.31","R10.32","F11.20","R41.82","Z74.3","I69.351","I69.320","I69.390","M79.2","R25.2","F11.10","F11.90","F15.90","Z90.49","F17.210","Z51.81","F15.20","Z79.899","Z11.1","F19.90","Z91.89","Z78.9","F11.23","I69.398","R07.9","R06.02","K29.70","R11.10","I69.341","Z68.25","M79.89","M79.644","W49.04XA","G40.909","R22.31","R52"],"date":["2019-01-28","2019-01-28","2019-01-28","2019-01-28","2019-01-28","2019-01-28","2021-09-08","2019-01-28","2019-01-28","2021-11-03","2020-08-05","2021-09-08","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2021-09-08","2021-11-03","2021-08-25","2021-11-03","2018-12-11","2018-12-11","2018-12-11","2018-12-11","2018-12-11","2018-12-14","2019-12-26","2019-12-26","2018-12-27","2018-12-27","2020-01-14","2020-01-14","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08"],"priorHcc":["","","","","","","","","",null,"","","","","","","","","","","","",null,"",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":[["","12496120803","SUBOXONE","MIS 8-2MG","","Select","Select",""],["","69097084615","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","","Select","Select",""],["","54018913","BUPREN\/NALOX","SUB 8-2MG","","Select","Select",""],["","33332042010","AFLURIA QUAD","INJ 2020-21","","Select","Select",""],["","69547035302","NARCAN","SPR ","","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","14","Select","Select",""],["","69097084615","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","65862052305","GABAPENTIN ","TAB 600MG","180","Select","Select",""],["","54018913","BUPREN\/NALOX ","SUB 8-2MG","14","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","33332042010","AFLURIA ","2020-21","0.5","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","33332042010","AFLURIA","2020-21","0.5","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","",""],["No","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":""}]}]}