{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHY L TAYLOR","gend":1,"add":"190 WINDY LANE ","city":"ROCKY MOUNT ","state":"VA","zip":"24151-9998","dob":"1954-10-14","age":"","mstatus":"","insh":11016942,"cliId":"1X66WR0PR40","pno":5402382029,"cno":5402382029,"email":"","ename":"","eno":"","pphy":"BENKO, FRANCES H  ","ppno":5404835168,"pcpadd":"796 Old Franklin Tpke","pcpcity":"Rocky Mount ","pcpstate":"VA","pcpzip":241515507,"pcpcounty":"","pcpid":"P0132300","pcpname":"CARILION CLINIC FAMILY MEDICINE ROCKY MOUNT","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"APT 8 ","add3":"","madd1":"190 WINDY LANE ","madd2":"APT 8 ","madd3":"","mcity":"ROCKY MOUNT ","mstate":"VA","mzip":"24151-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["G24.3","G40.909","E78.00","G60.9","M77.11","Z13.6","I73.9","R53.1","F17.200","R00.2","R94.31","I49.3","M54.50","W19.XXXA","R07.89","S72.012A","S72.002A","N39.0","X58.XXXA","S72.009A","M25.552","W01.0XXA","Y93.01","Y92.012","J44.9","I48.91","F17.210","S72.042A","N30.00","D72.829","R91.1","R11.2","M54.2","S82.899A","Z01.818","E78.5","I49.9","R25.1","M43.6","G62.9","Z72.3","Z04.3","R09.02","R91.8","Z98.890","B96.1","M81.0","J41.0","F32.A","E55.9","W18.30XA","G40.209","J98.11","Z20.822","M41.9","S72.002D","F33.9","Z91.81","Z79.82"],"date":["2021-07-07","2021-11-20","2021-10-19","2021-10-27","2021-04-28","2021-04-28","2021-07-07","2021-10-19","2021-07-07","2021-10-22","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-20","2021-10-27","2021-10-21","2021-10-19","2021-10-19","2021-10-20","2021-10-19","2021-10-19","2021-10-19","2021-11-20","2021-10-22","2021-10-22","2021-10-19","2021-10-21","2021-10-19","2021-10-22","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-22","2021-10-21","2021-10-21","2021-10-21","2021-11-20","2021-10-19","2021-10-19","2021-10-21","2021-10-20","2021-10-21","2021-10-22","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-11-20","2021-11-20","2021-11-20","2021-11-20"],"priorHcc":["",null,null,"","","","","","",null,"","","","","",null,"","","","","","","","",null,null,null,"","","",null,"","","","",null,"","","",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":[["","54001125","FLECAINIDE","TAB 100MG","","Select","Select",""],["","53746054501","PRIMIDONE","TAB 250MG","","Select","Select",""],["","65862052405","GABAPENTIN","TAB 800MG","","Select","Select",""],["","591533501","TRIHEXYPHEN","TAB 2MG","","Select","Select",""],["","93720298","PRAVASTATIN","TAB 40MG","","Select","Select",""],["","65862024608","LEVETIRACETA","TAB 500MG","","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","93720298","PRAVASTATIN ","TAB 40MG","30","Select","Select",""],["","65862024608","LEVETIRACETA ","TAB 500MG","60","Select","Select",""],["","53746054501","PRIMIDONE ","TAB 250MG","30","Select","Select",""],["","65862052405","GABAPENTIN ","TAB 800MG","105","Select","Select",""],["","70954021210","TRIHEXYPHEN ","TAB 2MG","90","Select","Select",""],["","54001125","FLECAINIDE ","TAB 100MG","90","Select","Select",""],["","65162083366","DICLOFENAC","0.01","100","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":""}]}]}