{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHY L NELSON","gend":1,"add":"1303 S DALTON AVE ","city":"COVINGTON","state":"VA","zip":"24426-9998","dob":"1961-04-20","age":"","mstatus":"","insh":11004859,"cliId":"9HV2AD5QM04","pno":5409589699,"cno":5407479964,"email":"","ename":"","eno":"","pphy":"KNISELY, THOMAS F ","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":"1303 S DALTON AVE ","madd2":"","madd3":"","mcity":"COVINGTON","mstate":"VA","mzip":"24426-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R11.2","B86","M96.1","M54.5","M12.9","M79.604","M70.61","B17.10","R73.09","E78.5","G57.10","Z79.899","Z79.891","G89.4","M47.26","M54.16","Z98.1","Z51.81","M46.1","M70.62","M22.41","M23.92","M22.42","S32.019A","X58.XXXA","Z71.9","I10","E03.8","F51.04","F41.9","L30.9","M85.80","F32.9","Z78.0","M25.551","S32.030A","T14.90XA","M48.56XA","W10.9XXA","Z20.828","G54.1","M48.061","M43.10","Z88.0","G89.29","K21.9","G47.00","S39.92XA","M81.0","M47.816","W19.XXXA","M79.606","S32.039A","R07.81","F17.200","M54.9","Z01.818","S32.009A","S32.030D","F43.21","F33.9","Z47.89","M62.81","F45.42","J40","H66.91","Z72.0","H92.01","R05","R07.9","M48.062","L03.115","M79.661","L03.116","L97.911","W22.8XXA","Y92.009","Z88.8","Z79.1","Z71.6","Z88.1","L97.919","F17.290","M62.9","L08.9","T14.8XXA","M54.31","S81.801D","Z91.81","S81.801A","M48.55XA","R21","L27.0","L30.8","G47.19","Z23","R29.898","M54.2","T81.89XA","M79.10","E78.49","E78.2","S22.009A","I82.409","L01.00","L28.1","M79.651","M79.89","M79.605","R60.0","J81.1","J44.9","F31.9","R06.02","R22.43","R59.1","L03.211","G62.9","T38.0X5A","Z88.2","L03.90","L89.892","G90.09","Z94.5","X58.XXXD","S32.030S","M85.89","M43.16","S32.000A","R30.0","F17.210","L29.9","F42.4","M79.18","M54.6","M54.50","M25.559","M62.838","M62.831","M54.59"],"date":["2019-01-01","2019-01-01","2021-10-12","2021-09-15","2021-09-15","2021-11-10","2021-11-10","2021-08-25","2020-01-27","2020-01-27","2021-04-21","2021-11-10","2021-02-25","2021-03-11","2019-02-08","2021-01-14","2021-10-05","2020-02-24","2021-11-10","2021-10-12","2020-03-18","2020-03-18","2020-03-18","2020-03-18","2021-03-11","2020-03-18","2021-10-05","2019-10-11","2019-04-11","2019-12-23","2021-04-14","2019-04-11","2020-06-01","2019-04-11","2020-05-22","2020-07-16","2021-10-05","2021-01-14","2020-05-22","2020-05-22","2020-05-22","2021-01-14","2020-05-22","2020-12-20","2021-10-05","2020-05-22","2020-05-22","2020-05-22","2020-05-22","2020-05-22","2020-05-26","2020-05-26","2020-05-22","2020-05-22","2020-12-20","2021-10-05","2020-05-25","2020-05-26","2021-01-14","2020-05-28","2020-05-28","2020-05-28","2020-05-28","2020-06-02","2019-07-05","2019-07-05","2019-07-05","2019-07-05","2019-07-05","2019-07-05","2020-07-23","2021-02-01","2020-08-18","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2020-12-20","2020-07-14","2020-07-14","2020-12-20","2020-09-18","2020-07-16","2021-11-02","2020-08-17","2021-07-14","2019-08-26","2020-11-04","2019-09-03","2020-12-22","2019-09-13","2021-07-14","2020-10-04","2020-10-07","2019-10-11","2019-10-11","2019-10-11","2019-10-11","2020-10-22","2018-10-30","2018-10-30","2018-10-30","2019-11-11","2019-11-21","2018-12-08","2021-07-14","2020-12-20","2020-12-20","2019-12-21","2019-12-21","2019-12-22","2019-12-23","2019-12-23","2019-12-23","2019-12-23","2019-12-23","2021-02-01","2020-12-20","2020-12-20","2020-12-20","2020-12-23","2021-02-01","2021-02-01","2021-02-01","2021-01-14","2021-01-14","2021-02-10","2021-03-11","2021-03-11","2021-03-12","2021-07-16","2021-07-14","2021-07-14","2021-08-25","2021-10-05","2021-10-12","2021-10-05","2021-10-05","2021-10-05","2021-11-10"],"priorHcc":["","","","","",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":[["","68382003516","VENLAFAXINE","CAP 75MG ER","","Select","Select",""],["","59651017501","DOXEPIN HCL","CAP 50MG","","Select","Select",""],["","14539067501","HYDROXYZ PAM","CAP 50MG","","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","","Select","Select",""],["","10702000710","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","43386035801","HYDROCO\/APAP","TAB 10-325MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","65862052301","GABAPENTIN","TAB 600MG","","Select","Select",""],["","10702005601","OXYCODONE","TAB 10MG","","Select","Select",""],["","93317431","ALBUTEROL SUL","FAT E","","Select","Select",""],["","68462022555","MOMETASONE","OIN 0.001","","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","597007541","SPIRIVA","CAP HANDIHLR","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","173088710","TRELEGY","AER ELLIPTA","","Select","Select",""],["","45802026937","PERMETHRIN","CRE 0.05","","Select","Select",""],["","72205001390","PREGABALIN","CAP 75MG","","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","168005646","BETAMETH DIP","OIN 0.0005","","Select","Select",""],["","173069600","ADVAIR DISKU","AER 250\/50","","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","71101468","LYRICA","CAP 75MG","","Select","Select",""],["","378064110","PREDNISONE","TAB 10MG","","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","43598075201","BUPROPION","TAB 150MG SR","","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","66993089749","AUG BETAMET","OIN 0.0005","","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","168001516","HYDROCORT","CRE 0.01","","Select","Select",""],["","69047103","CHANTIX","PAK 0.5& 1MG","","Select","Select",""],["","57664050658","METOPROL TAR","TAB 25MG","","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","603459315","METHYLPRED","TAB 4MG","","Select","Select",""],["","50742061510","METOPROL SUC","TAB 25MG ER","","Select","Select",""],["","59651017501","DOXEPIN ","CAP 50MG","90","Select","Select",""],["","57664050658","METOPROL ","TAB 25MG","90","Select","Select",""],["","68382003516","VENLAFAXINE ","CAP 75MG ER","90","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","10702000710","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","16571020210","DICLOFENAC ","TAB 50MG DR","60","Select","Select",""],["","43386035801","HYDROCO\/APAP ","TAB 10-325MG","120","Select","Select",""],["","14539067501","HYDROXYZ ","CAP 50MG","90","Select","Select",""],["","65862052301","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","168005646","BETAMETH ","OIN 0.0005","45","Select","Select",""],["","60505025203","TIZANIDINE ","TAB 4MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","10702005601","OXYCODONE ","TAB 10MG","120","Select","Select",""],["","68462022555","MOMETASONE ","OIN 0.001","45","Select","Select",""],["","378064205","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","42","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","173088710","TRELEGY ","AER ELLIPTA","60","Select","Select",""],["","72205001390","PREGABALIN ","CAP 75MG","60","Select","Select",""],["","45802026937","PERMETHRIN ","CRE 0.05","240","Select","Select",""],["","65162052110","PROMETHAZINE ","TAB 25MG","20","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","71101468","LYRICA ","CAP 75MG","60","Select","Select",""],["","43598075201","BUPROPION ","TAB 150MG SR","180","Select","Select",""],["","69315011610","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","40","Select","Select",""],["","168001516","HYDROCORT ","CRE 0.01","30","Select","Select",""],["","69047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","66993089749","AUG ","OIN 0.0005","50","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","603459315","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","10","Select","Select",""],["","69097015907","MELOXICAM ","15MG","90","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","116200116","CHLORHEX ","0.12%","16","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","57664050658","METOPROL","25MG","90","Select","Select",""],["","59651017501","DOXEPIN","50MG","90","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","14539067501","HYDROXYZ","50MG","90","Select","Select",""],["","00168005646","BETAMETH","0.0005","45","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10.2","Select","Select",""],["","66993089749","AUG","0.0005","50","Select","Select",""],["","60505279500","IBANDRONATE","150MG","3","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","28","Select","Select",""],["","00116200116","CHLORHEX","0.0012","16","Select","Select",""],["","00310737020","BUDES\/FORMOT ","AER 160-4.5","10.2","Select","Select",""],["","33342015053","IBANDRONATE ","TAB 150MG","3","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":""}]}]}