{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CASSANDRA L JENNINGS","gend":1,"add":"2426 WESTOVER AVE SW ","city":"ROANOKE  ","state":"VA","zip":"24015-9998","dob":"1990-01-27","age":"","mstatus":"","insh":11014050,"cliId":"3KY6TT8QA58","pno":5409155865,"cno":5409155865,"email":"","ename":"","eno":"","pphy":"LANTZ, JERI LYNN  ","ppno":5409858100,"pcpadd":"1030 S Jefferson St Ste 106","pcpcity":"Roanoke  ","pcpstate":"VA","pcpzip":240164418,"pcpcounty":"","pcpid":"P0117792","pcpname":"PARTRICK HENRY TEEN HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2426 WESTOVER AVE SW ","madd2":"","madd3":"","mcity":"ROANOKE  ","mstate":"VA","mzip":"24015-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F33.2","F60.3","I10","R42","R20.2","R53.1","E78.5","F32.9","F41.9","R20.0","F25.1","M25.552","M25.551","F31.30","F41.1","F43.10","Z72.89","S31.119A","M54.32","M25.561","M25.562","Z91.5","I15.8","F40.00","R00.0","M54.42","G89.29","F41.0","Z86.59","M51.36","M51.37","M51.26","M48.061","M51.27","M48.07","F42.8","F34.1","X83.8XXA","M70.61","M70.62","E66.9","F40.01","F40.11","F60.7","R63.5","M54.5","M79.605","F32.3","G47.10","G47.33","Z79.899","E66.3","G89.4","R45.851"],"date":["2020-07-01","2021-11-30","2021-10-13","2020-06-08","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2021-04-25","2020-06-08","2020-06-08","2020-08-13","2020-11-18","2021-10-12","2020-09-16","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2020-08-13","2021-09-13","2020-11-18","2021-09-13","2020-12-16","2020-10-06","2021-06-17","2020-11-18","2021-07-12","2020-12-16","2020-12-16","2020-12-16","2020-12-16","2020-12-16","2021-10-12","2021-10-12","2021-10-12","2021-01-11","2021-01-11","2021-04-12","2020-12-21","2020-12-28","2021-10-12","2021-04-12","2021-07-12","2021-07-12","2021-11-19","2021-08-23","2021-08-23","2021-11-10","2021-11-10","2021-11-10","2021-11-10"],"priorHcc":["",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":[["","16729021301","DOXAZOSIN","TAB 4MG","","Select","Select",""],["","69097084615","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","42806008660","BUSPIRONE","TAB 30MG","","Select","Select",""],["","68382000810","LAMOTRIGINE","TAB 100MG","","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","","Select","Select",""],["","65862069705","VENLAFAXINE","CAP 150MG ER","","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","","Select","Select",""],["","228282011","HYDROCHLOROT","TAB 12.5MG","","Select","Select",""],["","406117003","NALTREXONE","TAB 50MG","","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","50924097110","SOFTCLIX","MIS LANCETS","","Select","Select",""],["","65702040810","ACCU-CHEK","TES AVIVA PL","","Select","Select",""],["","47335079483","VENLAFAXINE ","TAB 225MG ER","7","Select","Select",""],["","16729021301","DOXAZOSIN ","TAB 4MG","7","Select","Select",""],["","406117003","NALTREXONE ","TAB 50MG","7","Select","Select",""],["","69097084615","CYCLOBENZAPR ","TAB 10MG","14","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","7","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","228282011","HYDROCHLOROT ","TAB 12.5MG","10","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","7","Select","Select",""],["","42806008660","BUSPIRONE ","TAB 30MG","14","Select","Select",""],["","68382000810","LAMOTRIGINE ","TAB 100MG","7","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","30","Select","Select",""],["","55111053301","DIVALPROEX ","TAB 250MG ER","7","Select","Select",""],["","65702072310","ACCU-CHEK ","KIT AVIVA PL","1","Select","Select",""],["","50924097110","SOFTCLIX ","MIS LANCETS","100","Select","Select",""],["","55111053401","DIVALPROEX","500MG ER","7","Select","Select",""],["","64764072030","TRINTELLIX","5MG","14","Select","Select",""],["","55111046605","METOPROL","25MG ER","7","Select","Select",""],["","55111046605","METOPROL ","TAB 25MG ER","7","Select","Select",""],["","64764072030","TRINTELLIX ","TAB 5MG","14","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","",""],["No","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":""}]}]}