{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROSE M BRENNIN","gend":1,"add":"10316 LEE HIGHWAY ","city":"FINCASTLE","state":"VA","zip":"24090-4465","dob":"1955-07-01","age":"","mstatus":"","insh":11009531,"cliId":"5UA3JC8JM80","pno":5409665754,"cno":5409665754,"email":"","ename":"","eno":"","pphy":"CIERASZYNSKI, LAURA  ","ppno":5403750600,"pcpadd":"2145 Mount Pleasant Blvd SE Ste 100","pcpcity":"Roanoke  ","pcpstate":"VA","pcpzip":240143632,"pcpcounty":"","pcpid":"P0117780","pcpname":"CARILION CLINIC FAMILY MEDICINE DALEVILLE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"10316 LEE HIGHWAY ","madd2":"","madd3":"","mcity":"FINCASTLE","mstate":"VA","mzip":"24090-4465","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I82.4Y9","M47.814","M54.6","G89.29","Z12.31","Z85.3","Z79.899","G89.4","M54.12","M54.14","M50.30","Z79.01","C50.211","E11.49","E78.2","I10","M25.561","M25.562","Z17.0","M51.36","M47.816","Z79.891","F41.1","K21.9","Z87.891","Z79.84","Z23","Z90.11","M85.80","E11.29","E66.01","R80.9","Z68.43","T78.3XXA","Z91.81","S00.521A","R19.7","H10.13","J30.9","L23.2","L71.9","Z77.120","Z68.42","B02.7"],"date":["2021-08-24","2020-02-06","2020-02-22","2020-02-06","2021-03-30","2021-03-30","2021-10-20","2021-10-20","2020-02-22","2020-02-22","2021-10-20","2021-08-24","2021-10-12","2021-11-17","2021-08-24","2021-11-17","2020-05-06","2020-05-06","2021-10-12","2021-10-20","2021-10-20","2021-10-20","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2021-10-26","2021-03-30","2021-04-13","2021-10-26","2021-10-06","2021-10-26","2021-08-24","2021-08-02","2021-04-20","2021-08-02","2021-06-18","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-11-12"],"priorHcc":["","","","","","","","","","","","","",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":[["","597014030","TRADJENTA","TAB 5MG","","Select","Select",""],["","68382020906","ANASTROZOLE","TAB 1MG","","Select","Select",""],["","42858010401","OXYCOD\/APAP","TAB 10-325MG","","Select","Select",""],["","70377000315","SIMVASTATIN","TAB 20MG","","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","","Select","Select",""],["","51672404601","ENALAPR\/HCTZ","TAB 10-25MG","","Select","Select",""],["","169406013","VICTOZA","INJ 18MG\/3ML","","Select","Select",""],["","68382003416","VENLAFAXINE","CAP 37.5 ER","","Select","Select",""],["","16729020301","BUSPIRONE","TAB 15MG","","Select","Select",""],["","8290320109","BD PEN NEEDL","MIS 31GX8MM","","Select","Select",""],["","33342032980","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","68382076010","METFORMIN","TAB 1000MG","","Select","Select",""],["","69097081507","GABAPENTIN","CAP 400MG","","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","93172001","WARFARIN","TAB 10MG","","Select","Select",""],["","3089421","ELIQUIS","TAB 5MG","","Select","Select",""],["","591565810","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","","Select","Select",""],["","597014030","TRADJENTA ","TAB 5MG","90","Select","Select",""],["","42858010401","OXYCOD\/APAP ","TAB 10-325MG","90","Select","Select",""],["","169406013","VICTOZA ","INJ 18MG\/3ML","18","Select","Select",""],["","69097081507","GABAPENTIN ","CAP 400MG","120","Select","Select",""],["","16729020301","BUSPIRONE ","TAB 15MG","270","Select","Select",""],["","68382003416","VENLAFAXINE ","CAP 37.5 ER","90","Select","Select",""],["","68382020906","ANASTROZOLE ","TAB 1MG","90","Select","Select",""],["","70377000315","SIMVASTATIN ","TAB 20MG","30","Select","Select",""],["","93172301","WARFARIN ","TAB 7.5MG","60","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","51672404601","ENALAPR\/HCTZ ","TAB 10-25MG","90","Select","Select",""],["","8290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","68382076010","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","33342032980","TRIAMCINOLON ","CRE 0.001","80","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","591565810","CYCLOBENZAPR ","TAB 10MG","90","Select","Select",""],["","3089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","53885024510","ONETOUCH ","ULTRA","400","Select","Select",""],["","55111032001","GLIMEPIRIDE","1MG","90","Select","Select",""],["","23155000810","HYDROCHLOROT","25MG","90","Select","Select",""],["","51672421503","METRONIDAZOL","1%","60","Select","Select",""],["","55111032001","GLIMEPIRIDE ","TAB 1MG","90","Select","Select",""],["","31722070090","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","51672421503","METRONIDAZOL ","GEL 0.01","60","Select","Select",""],["","23155000810","HYDROCHLOROT ","TAB 25MG","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":[[["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":""}]}]}