{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EDITH BISHOP","gend":1,"add":"6699 SLOWLY LN ","city":"RADFORD  ","state":"VA","zip":"24141-9998","dob":"1949-01-11","age":"","mstatus":"","insh":11004156,"cliId":"1R67VP0UR77","pno":5406394009,"cno":5406394009,"email":"","ename":"","eno":"","pphy":"MARCH, JARED","ppno":7578283238,"pcpadd":"2900 Lamb Cir,Ste 250","pcpcity":"Christiansburg ","pcpstate":"VA","pcpzip":240736345,"pcpcounty":"","pcpid":"P0117712","pcpname":"CARILION INTERNAL MEDICINE RADFORD","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"6699 SLOWLY LN ","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":["G47.33","F41.1","F34.1","R49.0","R13.10","H92.01","E04.9","R39.14","N19","I34.0","I13.0","I50.9","N18.9","I70.0","Q23.1","Q24.9","Z23","G47.30","J96.10","I50.30","E11.22","H91.92","I25.10","J45.909","Z99.81","Z86.73","Z79.82","E04.2","M81.0","K74.60","Z90.49","Z12.31","I10","J96.11","H90.3","N39.0","N28.9","D63.1","N25.81","N18.3","E55.9","N18.4","E11.9","R33.9","G43.909","M15.0","E78.00","E11.40","Z12.11","E05.90","C73","E05.20","H81.03","K21.9","M19.90","E66.9","D64.9","Z88.8","Z88.2","Z79.84","Z01.810","R00.1","I44.0","R94.31","K71.7","M15.9","E89.0","M54.5","N83.209","R06.09","R09.02","Z68.33","M48.56XA","S32.009A","M51.46","M47.816","S32.019A","S32.010D","Z01.812","S32.010G","E06.9","R79.89","K74.69","E66.2","Z68.37","R07.9","Z01.818","I50.32","G89.29","S22.080A","S32.010A","I12.9","X58.XXXA","Y92.9","I11.0","Z48.89","H25.12","K76.0","J96.12","I08.0","I38","I87.9","L65.9","K57.30","D12.3","K64.8","K63.5","K44.9","Z79.899","B00.1","H25.11","K20.8","E07.9","F32.1","E04.1","D31.90","Z68.35","G47.31","S83.91XA","M25.569","W19.XXXA","S32.000G","R68.89","S22.080D","M79.89","M51.35","M48.56XD","M51.36","M51.37","M43.8X6","M40.295","Z98.890","R60.0","R60.9","K75.81","I08.3","I51.9","R07.89","Z86.79","M17.11","M62.81","M25.561","Z99.89","N18.30","R11.0","S99.922A","S92.302A","S92.322A","S92.332A","S92.342A","S92.352A","N18.32","E11.65","S32.019D","Z85.850","M89.49","K57.90","S92.322D","S92.332D","S92.342D","S92.325D","R06.02","R00.2","E87.6","E83.42","K42.9","E11.36","H26.9","E11.42","E78.5","R10.31","R10.32","R35.0","R30.0","N17.9","Z79.4","R93.3","G45.9","R53.1","R26.89","R51.9","R26.81","R20.2","K86.2"],"date":["2021-08-06","2021-09-03","2021-09-03","2019-10-10","2019-10-10","2019-10-10","2019-12-18","2021-11-09","2021-11-09","2019-10-16","2019-12-18","2020-02-14","2021-11-15","2020-08-14","2021-08-06","2019-10-16","2021-03-03","2020-02-14","2019-10-16","2019-10-16","2021-11-18","2021-08-24","2020-02-11","2020-02-14","2020-02-14","2021-08-24","2019-10-16","2020-01-06","2021-06-28","2021-05-04","2020-10-19","2020-10-19","2021-08-06","2021-04-21","2019-10-24","2019-08-09","2019-08-09","2021-11-15","2021-08-06","2020-02-14","2021-05-12","2021-11-18","2021-09-01","2021-11-09","2019-04-03","2019-10-02","2021-08-06","2021-08-06","2019-06-10","2021-03-03","2021-05-24","2019-12-18","2019-12-18","2021-08-24","2019-12-18","2020-02-14","2021-08-24","2019-12-18","2019-12-18","2020-05-04","2020-02-11","2020-02-04","2020-02-04","2020-02-04","2020-05-04","2019-12-26","2021-08-24","2020-08-01","2020-01-06","2019-10-07","2019-01-10","2020-02-14","2020-01-25","2020-01-25","2020-01-25","2020-01-25","2020-01-25","2020-01-30","2020-02-04","2020-08-19","2020-05-01","2021-08-20","2019-09-20","2020-04-10","2019-09-20","2021-08-24","2020-02-13","2021-05-04","2020-02-14","2020-02-14","2020-02-14","2021-08-24","2020-02-14","2020-02-14","2020-02-14","2020-08-24","2019-05-16","2021-10-20","2019-04-19","2019-05-09","2019-05-09","2019-05-09","2019-05-14","2021-08-24","2019-06-10","2019-05-30","2019-06-10","2019-06-10","2021-08-20","2019-05-30","2019-06-04","2019-06-10","2019-06-14","2021-03-03","2019-07-05","2020-07-07","2019-07-15","2018-09-17","2018-07-23","2018-07-23","2020-08-01","2020-08-05","2020-08-14","2020-08-14","2020-08-19","2020-08-15","2020-08-15","2020-08-15","2020-08-15","2020-08-15","2020-08-15","2020-08-15","2021-05-04","2020-08-19","2020-09-01","2021-05-12","2018-09-10","2019-10-07","2019-10-07","2021-07-19","2021-07-19","2021-04-14","2021-05-03","2021-08-24","2021-08-06","2021-05-04","2021-05-07","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-11-18","2021-08-06","2020-08-15","2021-08-06","2021-08-06","2021-08-24","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-11-23","2021-11-18","2021-10-20","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-11-13"],"priorHcc":["","","","","","","",null,null,"","","",null,"","","","","","","",null,"","","","","","","","","","","","","","","","",null,"","","",null,"",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","",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":[["","65862076890","FENOFIBRATE","TAB 48MG","","Select","Select",""],["","67253090111","ALPRAZOLAM","TAB 0.5MG","","Select","Select",""],["","16729014517","QUETIAPINE","TAB 25MG","","Select","Select",""],["","33342015915","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","60505014201","GLIPIZIDE","TAB 10MG","","Select","Select",""],["","68382073201","NADOLOL","TAB 20MG","","Select","Select",""],["","13668002090","VENLAFAXINE","CAP 150MG ER","","Select","Select",""],["","68382031910","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","","Select","Select",""],["","68180097003","LEVOTHYROXIN","TAB 112MCG","","Select","Select",""],["","62332000131","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","6027731","JANUVIA","TAB 100MG","","Select","Select",""],["","52817033050","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","67877019810","AMLODIPINE","TAB 5MG","","Select","Select",""],["","69315011710","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","45802025735","MOMETASONE","CRE 0.001","","Select","Select",""],["","62037099910","POT CL MICRO","TAB 20MEQ ER","","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA BL","","Select","Select",""],["","57664078486","CLONAZEP ODT","TAB 0.25MG","","Select","Select",""],["","69547035302","NARCAN","SPR ","","Select","Select",""],["","72205000399","ROSUVASTATIN","TAB 10MG","","Select","Select",""],["","70461012003","FLUAD QUADRI","INJ 0.5ML","","Select","Select",""],["","65862064163","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","10702000310","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","27808003503","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","","Select","Select",""],["","69543013611","TRAMADOL ","TAB 50MG","180","Select","Select",""],["","69097045905","FENOFIBRATE ","TAB 48MG","30","Select","Select",""],["","68180097003","LEVOTHYROXIN ","TAB 112MCG","30","Select","Select",""],["","67877022310","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","16729014517","QUETIAPINE ","TAB 25MG","60","Select","Select",""],["","67877045005","TAMSULOSIN ","CAP 0.4MG","60","Select","Select",""],["","13668002090","VENLAFAXINE ","CAP 150MG ER","30","Select","Select",""],["","62332000131","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","45802025735","MOMETASONE ","CRE 0.001","60","Select","Select",""],["","67253090111","ALPRAZOLAM ","TAB 0.5MG","25","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","68382073301","NADOLOL ","TAB 40MG","30","Select","Select",""],["","57237016999","ROSUVASTATIN ","TAB 10MG","90","Select","Select",""],["","60505014201","GLIPIZIDE ","TAB 10MG","30","Select","Select",""],["","69315011710","FUROSEMIDE ","TAB 40MG","80","Select","Select",""],["","52817033050","CYCLOBENZAPR ","TAB 5MG","60","Select","Select",""],["","6027731","JANUVIA ","TAB 100MG","30","Select","Select",""],["","67877019810","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","27808003503","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","53885024510","ONETOUCH ","TES ULTRA BL","100","Select","Select",""],["","62037099910","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","57664078486","CLONAZEP ","TAB 0.25MG","30","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","185505001","METOLAZONE ","TAB 2.5MG","36","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","43386009019","GAVILYTE-G ","SOL ","4,000.00","Select","Select",""],["","70461012003","FLUAD ","INJ 0.5ML","0.5","Select","Select",""],["","65862064163","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","10702000310","PROMETHAZINE ","25MG","30","Select","Select",""],["","43386091710","POT  CHLORIDE","20MEQ ER","60","Select","Select",""],["","69543013611","TRAMADOL","50MG","180","Select","Select",""],["","65862018730","ONDANSETRON","4MG","30","Select","Select",""],["","57664078486","CLONAZEP","0.25MG","30","Select","Select",""],["","00185505001","METOLAZONE","2.5MG","36","Select","Select",""],["","70461012003","FLUAD","0.5ML","0.5","Select","Select",""],["","43386091710","POT CHLORIDE","20MEQ ER","120","Select","Select",""],["","49281012165","FLUZONE","2021-22","0.7","Select","Select",""],["","00169643810","LEVEMIR","FLEXTOUC","3","Select","Select",""],["","90166063132","PEN NEEDLES","31GX5MM","90","Select","Select",""],["","00169643810","LEVEMIR ","INJ FLEXTOUC","3","Select","Select",""],["","49281012165","FLUZONE ","INJ 2021-22","0.7","Select","Select",""],["","90166063132","PEN  NEEDLES  ","MIS 31GX5MM","90","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","",""],["Yes","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":""}]}]}