{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REGENIA L DICKERSON","gend":1,"add":"5125 COOKS LN  ","city":"DUBLIN","state":"VA","zip":"24084-9998","dob":"1965-07-14","age":"","mstatus":"","insh":11007844,"cliId":"2TU0DN6UH39","pno":5405774114,"cno":5407394718,"email":"","ename":"","eno":"","pphy":"LARD, CHAD T","ppno":5406748804,"pcpadd":"118 BROAD STREET","pcpcity":"DUBLIN","pcpstate":"VA","pcpzip":240843211,"pcpcounty":"","pcpid":"P0117811","pcpname":"CARILION CLINIC FAMILY MEDICINE DUBLIN","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"5125 COOKS LN  ","madd2":"","madd3":"","mcity":"DUBLIN","mstate":"VA","mzip":"24084-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["M51.37","M96.1","M54.16","M50.30","Z79.899","G89.4","J44.1","E11.65","I10","L40.50","F41.8","E78.5","F17.210","Z79.4","Z88.0","K04.7","M54.6","M54.5","Z23","J44.0","J20.9","J44.9","H69.82","K63.0","K08.89","E11.9","F17.200","Z79.84","E66.01","Z68.41","E88.81","G89.29","K08.409","K21.9","M19.90","Z72.0","Z79.51","Z79.891","Z82.49","Z83.3","Z88.5","G62.9","R68.89","Z12.11","J06.9","R35.0"],"date":["2020-01-03","2020-01-03","2021-09-15","2021-09-15","2021-06-23","2021-09-15","2020-04-28","2021-09-21","2021-09-21","2021-09-21","2020-10-27","2021-09-21","2020-04-28","2020-04-28","2020-04-28","2020-06-12","2021-09-15","2019-10-10","2020-10-27","2021-09-21","2021-09-21","2021-05-05","2019-10-29","2019-11-24","2019-11-24","2019-11-24","2021-04-14","2019-11-24","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2021-09-21","2019-12-12","2021-09-21","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2021-09-21","2021-05-05","2021-09-21","2021-04-14","2021-09-21"],"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":[["","43386035801","HYDROCO\/APAP","TAB 10-325MG","","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","2143480","TRULICITY","INJ 1.5\/0.5","","Select","Select",""],["","310737020","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","60505014201","GLIPIZIDE","TAB 10MG","","Select","Select",""],["","50924097110","SOFTCLIX","MIS LANCETS","","Select","Select",""],["","69097083305","SERTRALINE","TAB 25MG","","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","6027731","JANUVIA","TAB 100MG","","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","","Select","Select",""],["","65862020190","LOSARTAN POT","TAB 25MG","","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","65702040810","ACCU-CHEK","TES AVIVA PL","","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","53885044801","ONETOUCH","KIT ULTRA 2","","Select","Select",""],["","51991074790","DULOXETINE","CAP 30MG","","Select","Select",""],["","378064205","PREDNISONE","TAB 20MG","","Select","Select",""],["","45802006436","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","","Select","Select",""],["","57664017688","HYDROCO\/APAP ","TAB 10-325MG","120","Select","Select",""],["","6027731","JANUVIA ","TAB 100MG","90","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","50924097110","SOFTCLIX ","MIS LANCETS","100","Select","Select",""],["","69097083305","SERTRALINE ","TAB 25MG","90","Select","Select",""],["","60505014201","GLIPIZIDE ","TAB 10MG","180","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","2143480","TRULICITY ","INJ 1.5\/0.5","2","Select","Select",""],["","310737020","BUDES\/FORMOT ","AER 160-4.5","10.2","Select","Select",""],["","31722070090","LOSARTAN ","TAB 25MG","180","Select","Select",""],["","23155000810","HYDROCHLOROT ","TAB 25MG","90","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","68180021709","LOSARTAN\/HCT ","TAB 100-25","90","Select","Select",""],["","69097081312","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","50383077504","LIDOCAINE ","SOL 2% VISC","100","Select","Select",""],["","51991074790","DULOXETINE ","CAP 30MG","90","Select","Select",""],["","65702040810","ACCU-CHEK ","TES AVIVA PL","200","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","378064110","PREDNISONE ","TAB 10MG","21","Select","Select",""],["","45802006436","TRIAMCINOLON ","CRE 0.001","80","Select","Select",""],["","93317431","ALBUTEROL ","FAT E","25.5","Select","Select",""],["","53885024510","ONETOUCH ","TES ULTRA","100","Select","Select",""],["","31722070090","LOSARTAN","25MG","180","Select","Select",""],["","68180021709","LOSARTAN\/HCT","100-25","90","Select","Select",""],["","69097081312","GABAPENTIN","100MG","90","Select","Select",""],["","00093317431","ALBUTEROL","E","25.5","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","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":""}]}]}