{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY S HALL","gend":1,"add":"814 ENGLISH RD","city":"ROCKY MOUNT                   ","state":"VA","zip":"24151-9998","dob":"1933-07-30","age":"","mstatus":"","insh":11008442,"cliId":"4K68WA0VR20","pno":2767320248,"cno":2767320248,"email":"","ename":"","eno":"","pphy":"DOOLAN, AMY W","ppno":5405625753,"pcpadd":"3700 S Main St,","pcpcity":"Blacksburg","pcpstate":"VA","pcpzip":240607017,"pcpcounty":"","pcpid":"P0117333","pcpname":"CARILION FAMILY MEDICINE SOUTHEAST FAMILY MEDICAL","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"814 ENGLISH RD","madd2":"","madd3":"","mcity":"ROCKY MOUNT","mstate":"VA","mzip":"24151-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","G25.0","I48.0","R07.9","R00.2","R53.83","R00.1","R94.31","R07.89","R06.02","I12.9","E11.22","N18.3","Z86.73","Z79.01","Z86.718","I48.91","E78.00","I25.2","E11.42","Z90.5","E87.5","M89.8X8","M48.04","M48.061","M25.561","M62.81","R26.2","M25.461","M17.11","R93.7","I49.1","R07.2","Z79.84","I20.9","K21.9","Z90.49","M89.9","M51.44","M43.14","K44.9","D18.09","M54.5","I25.10","E78.5","E66.9","E11.9","Z79.02","Z79.899","N17.8","R26.89","R42","Z23","I67.82","I44.4","N18.9","M94.0","I48.4","G47.30","K57.92","K52.9","Z20.822","U07.1","N18.32","Z86.16","M47.812","M47.814","M47.816","B35.4","I48.3","R79.89","H91.90","H93.8X1","E78.2","K20.80","F41.8"],"date":["2021-09-27","2020-01-22","2020-09-22","2021-09-27","2020-02-04","2020-02-04","2021-09-27","2020-09-10","2020-02-04","2020-02-04","2021-05-17","2021-09-27","2020-09-10","2021-02-03","2020-09-22","2020-09-22","2020-09-10","2021-05-17","2020-09-22","2021-09-27","2021-09-27","2020-03-31","2020-09-10","2020-09-04","2020-09-04","2019-09-06","2019-09-06","2019-09-06","2019-09-06","2019-09-06","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2019-09-11","2019-09-11","2019-09-11","2019-09-11","2019-09-12","2019-09-12","2021-05-17","2020-09-22","2020-09-22","2020-09-22","2020-09-22","2020-09-22","2019-11-13","2019-11-26","2019-12-04","2021-09-27","2019-12-04","2019-12-05","2019-12-05","2019-12-06","2019-12-19","2019-12-19","2019-12-19","2019-12-19","2021-01-14","2021-01-18","2021-09-27","2021-02-03","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2021-06-23","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27"],"priorHcc":[null,"","",null,"","",null,"","","","",null,"","","","","","","",null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","",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":[["","68180098103","LISINOPRIL","TAB 20MG","","Select","Select",""],["","13668001105","CITALOPRAM","TAB 40MG","","Select","Select",""],["","65862035790","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","68382065105","ISOSORB MONO","TAB 60MG ER","","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","","Select","Select",""],["","76385011150","CARVEDILOL","TAB 6.25MG","","Select","Select",""],["","3089321","ELIQUIS","TAB 2.5MG","","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","43547027010","ROPINIROLE","TAB 1MG","","Select","Select",""],["","68382065105","ISOSORB ","TAB 60MG ER","90","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL ","TAB 75MG","90","Select","Select",""],["","13668001105","CITALOPRAM ","TAB 40MG","90","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","3089321","ELIQUIS ","TAB 2.5MG","180","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","180","Select","Select",""],["","76385011150","CARVEDILOL ","TAB 6.25MG","90","Select","Select",""],["","43547027010","ROPINIROLE ","TAB 1MG","90","Select","Select",""],["","93321930","KETOCONAZOLE ","2%","30","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","15","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","68382065105","ISOSORB","60MG ER","90","Select","Select",""],["","00093321930","KETOCONAZOLE","0.02","30","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","16729020001","BUSPIRONE","5MG","60","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","",""],["No","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":""}]}]}