{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAMUEL V LANDEROS SR","gend":0,"add":"4224 TENNESSEE AVE","city":"ROANOKE  ","state":"VA","zip":"24017-9998","dob":"1954-05-17","age":"","mstatus":"","insh":11007744,"cliId":"9UQ6Y14RX89","pno":5402048825,"cno":5402048825,"email":"","ename":"","eno":"","pphy":"AUSTIN, ANN ","ppno":5402245170,"pcpadd":"3 Riverside Cir","pcpcity":"Roanoke  ","pcpstate":"VA","pcpzip":240164955,"pcpcounty":"","pcpid":"P0117426","pcpname":"CARILION CLINIC INTERNAL MEDICINE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"4224 TENNESSEE AVE","madd2":"","madd3":"","mcity":"ROANOKE  ","mstate":"VA","mzip":"24017-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["E11.65","E78.5","I10","D72.829","E55.9","Z86.73","E78.1","R10.9","R41.0","R42","R74.8","E11.9","Z87.891","R10.32","N17.9","R91.1","J16.8","J18.9","R05","Z79.4","Z79.82","R50.9","R00.0","Z20.828","R06.02","E78.2","M79.10","E11.8","R91.8","Z09","Z87.09","J98.4","I25.10","Z23","E11.69","I63.9","Z12.11","N52.9"],"date":["2020-11-24","2020-06-29","2021-09-17","2020-11-24","2021-06-16","2021-06-16","2020-06-29","2019-07-04","2019-07-04","2019-07-04","2019-07-04","2021-06-28","2020-08-03","2019-07-04","2019-07-09","2019-09-27","2020-08-03","2020-09-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2021-06-16","2019-09-12","2019-09-17","2019-09-25","2019-09-25","2019-09-25","2019-09-25","2019-09-25","2020-11-24","2021-09-17","2021-07-30","2021-09-17","2021-09-17"],"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":[["","56151172301","INSULIN SYRG","MIS 1ML\/30G","","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","","Select","Select",""],["","65862029490","ROSUVASTATIN","TAB 10MG","","Select","Select",""],["","73070020315","INS ASP PROT","INJ FLEXPEN","","Select","Select",""],["","8554333702","AGAMATRIX","TES PRESTO","","Select","Select",""],["","193731221","CONTOUR","TES NEXT","","Select","Select",""],["","38396031618","LANCET MICRO","MIS THIN 33G","","Select","Select",""],["","16729000316","GLIMEPIRIDE","TAB 4MG","","Select","Select",""],["","169369619","NOVOLOG MIX","INJ FLEXPEN","","Select","Select",""],["","65862001005","METFORMIN","TAB 1000MG","","Select","Select",""],["","193658621","MICROLET","MIS LANCETS","","Select","Select",""],["","33342002208","LEVOFLOXACIN","TAB 500MG","","Select","Select",""],["","8554333702","AGAMATRIX ","TES PRESTO","100","Select","Select",""],["","193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","38396031618","LANCET ","MIS THIN 33G","100","Select","Select",""],["","56151172301","INSULIN ","MIS 1ML\/30G","100","Select","Select",""],["","65862029490","ROSUVASTATIN ","TAB 10MG","90","Select","Select",""],["","16729000316","GLIMEPIRIDE ","TAB 4MG","60","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","90","Select","Select",""],["","65862001005","METFORMIN ","TAB 1000MG","180","Select","Select",""],["","73070020315","INS ","INJ FLEXPEN","30","Select","Select",""],["","169369619","NOVOLOG ","INJ FLEXPEN","15","Select","Select",""],["","193658621","MICROLET ","MIS LANCETS","300","Select","Select",""],["","33342002208","LEVOFLOXACIN ","500MG","10","Select","Select",""],["","53885000810","ONETOUCH ","PLUS 33G","300","Select","Select",""],["","00378395305","ATORVASTATIN ","80MG","90","Select","Select",""],["","00169406013","VICTOZA ","18MG\/3ML","6","Select","Select",""],["","38396031618","LANCET","THIN 33G","100","Select","Select",""],["","56151172301","INSULIN","1ML\/30G","100","Select","Select",""],["","53885092701","ONETOUCH","VERIO RE","1","Select","Select",""],["","00378395305","ATORVASTATIN","80MG","90","Select","Select",""],["","73070020315","INS","FLEXPEN","30","Select","Select",""],["","00169369619","NOVOLOG","FLEXPEN","15","Select","Select",""],["","00169406012","VICTOZA","18MG\/3ML","6","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":""}]}]}