{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOSEPH M GRAVELY","gend":0,"add":"305 MILLER ST  ","city":"CHRISTIANSBURG ","state":"VA","zip":"24073-9998","dob":"1966-06-14","age":"","mstatus":"","insh":11015811,"cliId":"6W60TJ2AR28","pno":5406413302,"cno":5406413302,"email":"","ename":"","eno":"","pphy":"MOGEN, THOMAS C","ppno":5403816000,"pcpadd":"205 Roanoke St","pcpcity":"Christiansburg ","pcpstate":"VA","pcpzip":240733025,"pcpcounty":"","pcpid":"P0117368","pcpname":"CARILION FAMILY MEDICINE CHRISTIANBURG","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"305 MILLER ST  ","madd2":"","madd3":"","mcity":"CHRISTIANSBURG ","mstate":"VA","mzip":"24073-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["F31.81","F90.0","F41.0","F51.05","Z79.899","F99","G89.4","M47.816","M54.16","H60.503","N52.9","M54.9","R35.0","E55.9","M54.5","R63.1","M25.561","Z20.828","U07.1","Z03.818","T39.391A","F39","I10","B20","R05","H40.9","R53.83","F41.8","R20.0","Z86.16","R14.0","R10.84","R10.9","F31.9","G56.21","G56.11","K60.2","K64.0","M54.12","M54.2","Z20.822","F31.70","Z23","K21.9","E03.2"],"date":["2021-04-19","2021-10-26","2021-06-11","2021-09-02","2021-11-15","2021-09-02","2021-11-15","2021-11-15","2021-11-15","2020-09-25","2020-09-25","2020-11-09","2020-11-16","2020-11-16","2020-12-11","2020-11-16","2020-12-11","2021-02-27","2021-03-08","2021-09-10","2020-11-27","2021-04-16","2021-10-26","2021-10-26","2021-03-08","2021-03-30","2021-10-26","2021-04-16","2021-05-03","2021-05-03","2021-06-10","2021-06-10","2021-06-10","2021-06-11","2021-08-02","2021-08-02","2021-07-12","2021-07-12","2021-09-01","2021-09-01","2021-09-10","2021-10-01","2021-10-01","2021-10-26","2021-10-26"],"priorHcc":["","","","",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":[["","185067405","HYDROXYZ PAM","CAP 25MG","","Select","Select",""],["","61958210101","ODEFSEY","TAB ","","Select","Select",""],["","13107004505","OXYCOD\/APAP","TAB 7.5-325","","Select","Select",""],["","51224002218","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","71093011205","GABAPENTIN","TAB 800MG","","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","","Select","Select",""],["","47781064010","LEVOTHYROXIN","TAB 25MCG","","Select","Select",""],["","69097012315","TOPIRAMATE","TAB 50MG","","Select","Select",""],["","70954006030","PREDNISONE","TAB 20MG","","Select","Select",""],["","55111012705","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","29300014901","QUETIAPINE","TAB 100MG","","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","68382095401","AMPHET\/DEXTR","TAB 15MG","","Select","Select",""],["","50228043605","NAPROXEN","TAB 500MG","","Select","Select",""],["","33332032001","AFLURIA QUAD","INJ 2020-21","","Select","Select",""],["","24208041005","OFLOXACIN","DRO 0.3%OTIC","","Select","Select",""],["","31722070110","LOSARTAN POT","TAB 50MG","","Select","Select",""],["","61958210101","ODEFSEY ","TAB ","30","Select","Select",""],["","185067405","HYDROXYZ ","CAP 25MG","60","Select","Select",""],["","13107004505","OXYCOD\/APAP ","TAB 7.5-325","180","Select","Select",""],["","71093011205","GABAPENTIN ","TAB 800MG","120","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","20","Select","Select",""],["","31722070110","LOSARTAN ","TAB 50MG","90","Select","Select",""],["","51224002218","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","47781064010","LEVOTHYROXIN ","TAB 25MCG","90","Select","Select",""],["","69097012315","TOPIRAMATE ","TAB 50MG","180","Select","Select",""],["","70954006030","PREDNISONE ","TAB 20MG","12","Select","Select",""],["","55111012705","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","29300014901","QUETIAPINE ","TAB 100MG","90","Select","Select",""],["","68382095401","AMPHET\/DEXTR ","TAB 15MG","180","Select","Select",""],["","43547028111","ESCITALOPRAM ","TAB 10MG","90","Select","Select",""],["","50228043605","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","29300011101","LAMOTRIGINE ","TAB 25MG","60","Select","Select",""],["","24208041005","OFLOXACIN ","DRO 0.3%OTIC","5","Select","Select",""],["","33332032001","AFLURIA ","INJ 2020-21","0.5","Select","Select",""],["","00185067405","HYDROXYZ","25MG","60","Select","Select",""],["","29300011101","LAMOTRIGINE","25MG","60","Select","Select",""],["","31722070110","LOSARTAN","50MG","90","Select","Select",""],["","33332032001","AFLURIA","2020-21","0.5","Select","Select",""],["","00378668910","PANTOPRAZOLE ","TAB 40MG","30","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","",""],["Yes","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":""}]}]}