{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VIRGINIA F ROGERS","gend":1,"add":"117 ALLEGHANY ST  ","city":"CLIFTON FORGE  ","state":"VA","zip":"24422-9998","dob":"1942-02-27","age":"","mstatus":"","insh":11007266,"cliId":"5YH4GF1FC96","pno":5408620832,"cno":5408620832,"email":"","ename":"","eno":"","pphy":"VOEKLER, SUSANNE E","ppno":5409770900,"pcpadd":"4615 Huntridge Rd","pcpcity":"Roanoke  ","pcpstate":"VA","pcpzip":240128510,"pcpcounty":"","pcpid":"P0114066","pcpname":"LEWIS GALE PHYSICIANS LLC","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"N","ano":"","add2":"","add3":"","madd1":"117 ALLEGHANY ST  ","madd2":"","madd3":"","mcity":"CLIFTON FORGE  ","mstate":"VA","mzip":"24422-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R30.0","R35.0","I10","I48.20","R06.02","I36.1","N18.3","N39.0","E55.9","K59.00","D32.0","I67.1","I72.9","I67.82","H18.723","M47.812","K08.109","Z98.890","D32.9","Q28.3","I48.21","I48.2","R60.9","R60.0","I25.10","Z01.818","Z79.01","Z79.899","R93.0","D18.00","Z86.011","G45.9","D64.9","R41.2","M81.0","H35.3134","R46.89","H35.3221","H35.3211","I48.91","C80.1","M54.2","S09.90XA","S00.03XA","Z04.3","S00.83XA","W01.10XA","Y92.512","E78.5","I48.92","W01.0XXA","N89.8","W19.XXXD","R51.9","W19.XXXA","I48.0","I49.3","E78.2","I51.7","G47.00","H35.3232","H25.13","H02.831","H25.813","R10.9","M54.9","R79.1","E66.9","Z90.49","Z68.41","R42"],"date":["2021-06-17","2021-09-20","2021-09-23","2021-09-23","2020-05-04","2020-05-04","2020-05-04","2021-09-20","2021-09-20","2021-07-03","2021-07-05","2021-07-21","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2021-07-21","2021-07-21","2020-05-04","2019-09-27","2020-05-27","2020-09-14","2021-09-23","2020-06-09","2021-07-03","2020-06-12","2020-06-12","2021-01-27","2020-06-18","2020-09-14","2021-01-11","2020-09-14","2021-09-20","2020-10-05","2021-09-23","2021-02-08","2021-03-22","2021-07-03","2020-10-26","2021-01-06","2021-01-06","2021-01-19","2021-01-06","2021-01-06","2021-01-06","2021-01-06","2021-07-03","2021-01-19","2021-01-06","2021-01-11","2021-01-11","2021-01-19","2021-01-27","2021-08-27","2021-08-25","2021-08-25","2021-08-25","2021-09-20","2021-11-08","2021-04-26","2021-04-26","2021-11-08","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-09-20"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","16729018201","HYDROCHLOROT","TAB 12.5MG","","Select","Select",""],["","68382065005","ISOSORB MONO","TAB 30MG ER","","Select","Select",""],["","70436015301","POT CHLORIDE","TAB 20MEQ ER","","Select","Select",""],["","68180021509","LOSARTAN\/HCT","TAB 50-12.5","","Select","Select",""],["","59651005290","EZETIMIBE","TAB 10MG","","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","","Select","Select",""],["","13668042990","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","76385011350","CARVEDILOL","TAB 25MG","","Select","Select",""],["","51672128902","NYSTATIN","CRE 100000","","Select","Select",""],["","93172101","WARFARIN","TAB 5MG","","Select","Select",""],["","65862020290","LOSARTAN POT","TAB 50MG","","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","68180030360","CEFUROXIME","TAB 500MG","","Select","Select",""],["","70461012003","FLUAD QUADRI","INJ 0.5ML","","Select","Select",""],["","59651005290","EZETIMIBE ","TAB 10MG","90","Select","Select",""],["","16729018201","HYDROCHLOROT ","TAB 12.5MG","90","Select","Select",""],["","70436015301","POT  CHLORIDE","TAB 20MEQ ER","60","Select","Select",""],["","68180021509","LOSARTAN\/HCT ","TAB 50-12.5","90","Select","Select",""],["","68382065005","ISOSORB ","TAB 30MG ER","90","Select","Select",""],["","76385011350","CARVEDILOL ","TAB 25MG","180","Select","Select",""],["","93172101","WARFARIN ","TAB 5MG","90","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","65862020290","LOSARTAN ","TAB 50MG","90","Select","Select",""],["","13668042990","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","51672128902","NYSTATIN ","CRE 100000","30","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","68180030360","CEFUROXIME ","TAB 500MG","20","Select","Select",""],["","70461012003","FLUAD ","0.5ML","0.5","Select","Select",""],["","45802006535","TRIAMCINOLON ","0.005","30","Select","Select",""],["","70710113803","FLUCONAZOLE ","100MG","10","Select","Select",""],["","43547027509","DONEPEZIL ","5MG","90","Select","Select",""],["","68382065005","ISOSORB","30MG ER","90","Select","Select",""],["","65862020290","LOSARTAN","50MG","90","Select","Select",""],["","45802006535","TRIAMCINOLON","0.005","30","Select","Select",""],["","43547027509","DONEPEZIL","5MG","90","Select","Select",""],["","70710113803","FLUCONAZOLE","100MG","10","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","70461012003","FLUAD","0.5ML","0.5","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","49281012165","FLUZONE","2021-22","0.7","Select","Select",""],["","13668000905","CITALOPRAM","10MG","90","Select","Select",""],["","49281012165","FLUZONE ","INJ 2021-22","0.7","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","13668000905","CITALOPRAM ","TAB 10MG","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}