{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"COREY J GRAVELY","gend":0,"add":"175 LAUREL DR  ","city":"MARTINSVILLE","state":"VA","zip":"24112-9998","dob":"1985-09-03","age":"","mstatus":"","insh":11015261,"cliId":"5E56EQ3WP55","pno":2766324598,"cno":2766324598,"email":"","ename":"","eno":"","pphy":"ISERNIA, JAMES M  ","ppno":2766660070,"pcpadd":"319 Hospital Dr Ste 19","pcpcity":"Martinsville","pcpstate":"VA","pcpzip":241121948,"pcpcounty":"","pcpid":"P0060037","pcpname":"PRIMARY CARE ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"175 LAUREL DR  ","madd2":"","madd3":"","mcity":"MARTINSVILLE","mstate":"VA","mzip":"24112-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","N18.9","I83.892","F17.210","G47.30","J45.909","G47.33","E66.9","G89.4","F41.0","M54.9","G47.00","I49.9","K59.00","K29.70","R10.9","J44.9","R73.03","R53.1","E66.01","J45.902","K29.60","R60.9","R00.8","F17.200","I49.8"],"date":["2021-11-17","2021-08-10","2020-08-26","2020-08-26","2021-04-15","2020-08-26","2021-08-10","2021-05-10","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-08-10","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-11-17","2020-09-28","2021-04-15","2021-05-10","2021-05-20","2021-08-10","2021-11-17"],"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":[["","23155000301","HYDRALAZINE","TAB 50MG","","Select","Select",""],["","31722070110","LOSARTAN POT","TAB 50MG","","Select","Select",""],["","54429731","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","65862067899","ALPRAZOLAM","TAB 1MG","","Select","Select",""],["","228212810","CLONIDINE","TAB 0.2MG","","Select","Select",""],["","54001925","PREDNISONE","TAB 50MG","","Select","Select",""],["","10702005601","OXYCODONE","TAB 10MG","","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","121087316","LACTULOSE","SOL 10GM\/15","","Select","Select",""],["","65862053750","LEVOFLOXACIN","TAB 500MG","","Select","Select",""],["","53746051105","SPIRONOLACT","TAB 25MG","","Select","Select",""],["","50111045001","TRAZODONE","TAB 150MG","","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","","Select","Select",""],["","186037020","SYMBICORT","AER 160-4.5","","Select","Select",""],["","10702005601","OXYCODONE ","TAB 10MG","60","Select","Select",""],["","54429731","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","31722052101","HYDRALAZINE ","TAB 50MG","60","Select","Select",""],["","31722070110","LOSARTAN ","TAB 50MG","30","Select","Select",""],["","50111045001","TRAZODONE ","TAB 150MG","30","Select","Select",""],["","228212810","CLONIDINE ","TAB 0.2MG","90","Select","Select",""],["","65862067899","ALPRAZOLAM ","TAB 1MG","60","Select","Select",""],["","54001925","PREDNISONE ","TAB 50MG","10","Select","Select",""],["","93106101","SOTALOL ","TAB 80MG","90","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","20","Select","Select",""],["","121087316","LACTULOSE ","SOL 10GM\/15","300","Select","Select",""],["","68382004001","PROMETHAZINE ","TAB 12.5MG","15","Select","Select",""],["","65862053750","LEVOFLOXACIN ","500MG","7","Select","Select",""],["","186037020","SYMBICORT ","160-4.5","10.2","Select","Select",""],["","53746051105","SPIRONOLACT ","25MG","30","Select","Select",""],["","31722070110","LOSARTAN","50MG","30","Select","Select",""],["","00093106101","SOTALOL","80MG","90","Select","Select",""],["","00002143380","TRULICITY","0.75\/0.5","2","Select","Select",""],["","00781185220","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00002143380","TRULICITY ","INJ 0.75\/0.5","2","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","",""],["Yes","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":""}]}]}