{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LACY HARTMAN","gend":1,"add":"9182 OLD MILL RD","city":"GLADE SPRING","state":"VA","zip":"24382-5011","dob":"1948-11-08","age":"","mstatus":"","insh":11004772,"cliId":"4T84Q80PX65","pno":2762060644,"cno":2764291060,"email":"","ename":"","eno":"","pphy":"THOMAS, KARI","ppno":2762288686,"pcpadd":"1375 W Ridge Rd","pcpcity":"Wytheville","pcpstate":"VA","pcpzip":"24382-5011","pcpcounty":"","pcpid":"P0117769","pcpname":"CARILION FAMILY MEDICINE FORT DEFIANCE","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"GLADE SPRING","mstate":"VA","mzip":"24340-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E03.9","I10","R53.83","L30.9","K21.9","M10.072","M79.672","M79.7","F41.1","R39.81","R15.9","R10.9","K59.00","K52.832","Z79.899","G47.00","F32.9","M1A.30X0","M62.81","R07.89","R07.81","M25.552","Y04.8XXA","E78.5","R10.11","S79.912A","Z03.818","Z23","M25.511","S46.011A","R13.10","R19.7","Z12.31","Z12.39","R92.1","M75.121","K51.90","Z01.818","Z20.822","K44.9","F41.9","R13.19","R50.9","R05","R51","Z20.828","M62.838","R21","G89.29","M75.122","K29.70","Z91.81","M54.5","R32","L71.9","E66.9","Z68.28","M75.101"],"date":["2021-03-11","2020-12-15","2019-01-21","2020-05-19","2021-02-17","2020-02-18","2020-02-18","2020-02-18","2020-02-18","2021-04-16","2021-04-16","2021-02-25","2019-04-03","2021-02-15","2021-03-11","2020-10-13","2021-03-11","2020-05-19","2019-08-22","2020-08-15","2020-08-15","2020-08-15","2020-08-15","2020-12-15","2020-08-15","2020-08-15","2020-10-05","2020-11-13","2021-04-15","2020-12-08","2021-03-11","2021-02-15","2020-12-14","2020-12-14","2020-12-14","2021-02-17","2021-02-17","2021-03-05","2021-03-05","2021-03-11","2021-03-11","2021-03-11","2020-09-18","2020-09-18","2020-09-18","2020-09-18","2020-10-13","2020-11-13","2020-11-13","2020-12-15","2020-12-15","2020-12-15","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2021-04-15"],"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":[["","67877051310","ATORVASTATIN","CAL CIUM ORAL","","Select","Select",""],["","69315011710","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","65862052405","GABAPENTIN","TAB 800MG","","Select","Select",""],["","574027501","POT CHLORIDE","TAB 10MEQ ER","","Select","Select",""],["","43547035411","LISINOPRIL","TAB 20MG","","Select","Select",""],["","33342020010","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","67877025001","QUETIAPINE","TAB 100MG","","Select","Select",""],["","68382043528","MESALAMINE","TAB 800MG DR","","Select","Select",""],["","527058601","DICYCLOMINE","CAP 10MG","","Select","Select",""],["","45802012932","HALOBETASOL","CRE 0.0005","","Select","Select",""],["","13668002090","VENLAFAXINE","CAP 150MG ER","","Select","Select",""],["","591544310","PREDNISONE","TAB 20MG","","Select","Select",""],["","29300016910","TIZANIDINE","TAB 4MG","","Select","Select",""],["","64380080308","RANITIDINE","TAB 150MG","","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","","Select","Select",""],["","55111072910","ALLOPURINOL","TAB 100MG","","Select","Select",""],["","16729029917","TRAZODONE","TAB 50MG","","Select","Select",""],["","67253090211","ALPRAZOLAM","TAB 1MG","","Select","Select",""],["","59762371809","TRIAZOLAM","TAB 0.25MG","","Select","Select",""],["","68682011102","PIMECROLIMUS","CRE 0.01","","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","31722057390","ESOMEPRA MAG","CAP 40MG DR","","Select","Select",""],["","76385012301","METHOCARBAM","TAB 500MG","","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","","Select","Select",""],["","59762045001","COLESTIPOL","TAB 1GM","","Select","Select",""],["","378668910","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","13668048201","MINOCYCLINE","CAP 50MG","","Select","Select",""],["","67877025115","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","67877025001","QUETIAPINE ","TAB 100MG","30","Select","Select",""],["","16729004617","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","50228017805","GABAPENTIN ","TAB 800MG","405","Select","Select",""],["","43547035411","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","68382043528","MESALAMINE ","TAB 800MG DR","60","Select","Select",""],["","527058601","DICYCLOMINE ","CAP 10MG","84","Select","Select",""],["","69315011710","FUROSEMIDE ","TAB 40MG","60","Select","Select",""],["","45802012932","HALOBETASOL ","CRE 0.0005","50","Select","Select",""],["","33342020010","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","29300016910","TIZANIDINE ","TAB 4MG","270","Select","Select",""],["","574027501","POT  CHLORIDE","TAB 10MEQ ER","60","Select","Select",""],["","93738505","VENLAFAXINE ","CAP 75MG ER","30","Select","Select",""],["","67253090211","ALPRAZOLAM ","TAB 1MG","90","Select","Select",""],["","55111072910","ALLOPURINOL ","TAB 100MG","30","Select","Select",""],["","76385012301","METHOCARBAM ","TAB 500MG","120","Select","Select",""],["","16729016917","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","68682011102","PIMECROLIMUS ","CRE 0.01","60","Select","Select",""],["","591544310","PREDNISONE ","TAB 20MG","14","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","16729029917","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","64380080308","RANITIDINE ","TAB 150MG","30","Select","Select",""],["","59762045001","COLESTIPOL ","TAB 1GM","60","Select","Select",""],["","378668910","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","13668001005","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","31722057390","ESOMEPRA ","CAP 40MG DR","30","Select","Select",""],["","59762371809","TRIAZOLAM ","TAB 0.25MG","60","Select","Select",""],["","13668048201","MINOCYCLINE ","CAP 50MG","60","Select","Select",""],["","67877025115","TRIAMCINOLON ","CRE 0.001","15","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}