{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICIA G SNEAD","gend":1,"add":"692VOLLEY HUDSON ROAD","city":"MONROE","state":"VA","zip":"24574-2953","dob":"1966-11-02","age":"","mstatus":"","insh":11015290,"cliId":"7AY6JQ7GC89","pno":5405974298,"cno":5405974298,"email":"","ename":"","eno":"","pphy":"BEIRNE, TIMOTHY M ","ppno":5409836700,"pcpadd":"415 S Pollard St","pcpcity":"Vinton","pcpstate":"VA","pcpzip":241792502,"pcpcounty":"","pcpid":"P0125174","pcpname":"CARILION FAMILY MEDICINE PARKWAY PHYSICIANS VINT","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"692VOLLEY HUDSON ROAD","madd2":"","madd3":"","mcity":"MONROE","mstate":"VA","mzip":"24574-2953","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z22.7","N61.1","B18.2","A15.9","L02.91","J84.10","R92.2","N63.21","R92.1","R60.9","N61.0","G83.4","R15.9","R53.1","M51.26","M47.22","M12.9","M47.817","Z98.1","M48.00","R29.898","M48.061","M48.02","E11.9","Z20.828","K21.9","E03.9","F17.290","G89.29","R32","M54.12","Z91.81","J44.9","M51.9","Z01.818","R53.81","R26.9","R52","M79.2","K59.2","N31.9","Z79.2","Z48.89","M47.26","Z47.89","G95.9","G82.20","M46.26","J45.909","B19.20","M54.5","M54.2","F34.1","F17.210","M25.522","S39.92XA","S19.9XXA","S29.9XXA","Z04.3","F33.1","M43.22","M50.323","M43.16","M54.9","F31.9","Z01.810","E11.69","F32.9","F41.9","Z79.891","N39.41","Z51.81","M62.81","Z48.816","I10","M79.7","G89.4","F12.90","M51.36","M50.121","M51.24","Z79.899","Z86.19","M50.30","M43.12"],"date":["2020-09-03","2020-09-30","2021-02-04","2020-09-11","2021-01-15","2020-09-11","2020-09-30","2020-09-15","2020-09-30","2020-09-30","2021-01-15","2020-12-10","2021-08-09","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2021-10-18","2020-12-11","2020-12-11","2021-02-04","2021-08-11","2020-12-17","2020-12-15","2021-02-04","2021-08-09","2020-12-10","2021-02-04","2021-02-04","2021-07-01","2021-02-04","2020-12-10","2020-12-15","2020-12-10","2020-12-17","2020-12-31","2020-12-31","2020-12-31","2020-12-31","2020-12-31","2021-01-15","2021-01-22","2020-12-11","2021-02-04","2020-12-17","2020-12-17","2021-02-04","2021-04-08","2020-12-17","2021-08-27","2021-08-27","2020-12-17","2020-12-17","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-30","2020-12-30","2021-10-18","2021-03-26","2021-04-08","2021-04-08","2020-12-10","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-11-05","2021-08-27","2021-06-30","2020-08-21","2020-12-10","2020-12-10","2021-08-27","2021-08-27","2020-12-11","2021-08-11","2020-12-10","2020-12-10","2020-12-10","2021-09-01","2021-10-18"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","65862052305","GABAPENTIN","TAB 600MG","","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","","Select","Select",""],["","42858000201","OXYCODONE","TAB 10MG","","Select","Select",""],["","378180910","LEVOTHYROXIN","TAB 100MCG","","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","","Select","Select",""],["","68382003516","VENLAFAXINE","CAP 75MG ER","","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","","Select","Select",""],["","24658031205","DOXYCYCL HYC","TAB 100MG","","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","65862052305","GABAPENTIN ","TAB 600MG","90","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","42","Select","Select",""],["","832105410","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","378180910","LEVOTHYROXIN ","TAB 100MCG","90","Select","Select",""],["","71093014005","METHOCARBAM ","TAB 500MG","120","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","60","Select","Select",""],["","24658031205","DOXYCYCL ","TAB 100MG","60","Select","Select",""],["","16571020106","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","68382003516","VENLAFAXINE ","CAP 75MG ER","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","60505025203","TIZANIDINE ","TAB 4MG","45","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","1","Select","Select",""],["","173069600","ADVAIR ","250\/50","60","Select","Select",""],["","68180096301","ALBUTEROL ","HFA","8.5","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","00832105410","BACLOFEN","10MG","90","Select","Select",""],["","24658031205","DOXYCYCL","100MG","60","Select","Select",""],["","65862050320","AMOX\/K","875-125","60","Select","Select",""],["","49884064101","METHIMAZOLE","10MG","90","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","68180096301","ALBUTEROL","HFA","8.5","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","1","Select","Select",""],["","23155007101","METHIMAZOLE ","TAB 10MG","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":""}]}]}