{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BEATRICE F SORAH","gend":1,"add":"2100 HAMMES ST APT A ","city":"CHRISTIANSBURG","state":"VA","zip":"24073-9998","dob":"1952-12-17","age":"","mstatus":"","insh":11017108,"cliId":"9M59YA0FJ31","pno":5402506637,"cno":5402500637,"email":"","ename":"","eno":"","pphy":"GUERRA, PETE ALEXIS ","ppno":5403810820,"pcpadd":"215 Roanoke St, ","pcpcity":"Christiansburg","pcpstate":"VA","pcpzip":240733025,"pcpcounty":"","pcpid":"P0124319","pcpname":"FREE CLINIC OF THE NEW RIVER VALLEY","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"2100 HAMMES ST APT A","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":["F20.0","A41.9","L03.115","L03.116","E87.1","N17.9","R65.20","E10.65","E10.22","N18.30","I12.9","F20.9","E78.5","Z90.49","J44.9","R29.6","F41.9","Z88.6","E44.0","F25.9","L03.90","E11.49","J43.1","E11.65","Z20.822","S72.141A","W19.XXXA","L53.9","M54.2","I10","K21.9","Z79.4","E11.51","I87.2","L97.822","L97.812","E11.22","D63.1","E66.9","F32.9","M25.522","M25.562","S82.002A","W18.39XA","S82.092A","E11.9","Z48.00","K57.90","S82.035D","R29.898","Z72.0","Z78.9","D50.9","L03.119","E44.1","T76.01XA","D63.8","F17.200","N18.32","R91.8","R06.02","R09.02","S82.035A","D64.9","R22.41","R22.42","D72.829","R41.82","L97.811","L97.821","B95.62","I13.0","I50.9"],"date":["2021-03-01","2021-03-27","2021-08-08","2021-08-08","2021-01-19","2021-08-04","2021-01-23","2021-01-23","2021-01-19","2021-06-25","2021-08-04","2021-08-19","2021-08-08","2021-01-19","2021-08-08","2021-04-20","2021-08-04","2021-01-19","2021-01-19","2021-06-25","2021-04-20","2021-01-19","2021-01-19","2021-08-08","2021-01-19","2021-01-21","2021-03-03","2021-01-25","2021-01-25","2021-04-20","2021-08-08","2021-04-20","2021-08-08","2021-08-08","2021-06-25","2021-06-25","2021-08-08","2021-06-25","2021-06-25","2021-06-25","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-04-20","2021-08-08","2021-06-25","2021-04-09","2021-04-09","2021-04-20","2021-04-20","2021-08-08","2021-08-04","2021-08-05","2021-08-04","2021-08-04","2021-08-04","2021-08-08","2021-08-05","2021-08-05","2021-08-05","2021-04-30","2021-08-04","2021-08-04","2021-08-04","2021-08-05","2021-08-04","2021-08-08","2021-08-08","2021-08-08","2021-08-08","2021-08-08"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","88221905","LANTUS SOLOS","INJ 100\/ML","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","185041501","BUPROPION","TAB 150MG SR","","Select","Select",""],["","68382009201","CARVEDILOL","TAB 3.125MG","","Select","Select",""],["","88222033","LANTUS","INJ 100\/ML","","Select","Select",""],["","168005415","NYSTATIN","CRE 100000","","Select","Select",""],["","8290320122","BD PEN NEEDL","MIS 32GX4MM","","Select","Select",""],["","27808003503","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","2143480","TRULICITY","INJ 1.5\/0.5","","Select","Select",""],["","43547040710","CLONAZEPAM","TAB 1MG","","Select","Select",""],["","60505257908","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","63402030430","LATUDA","TAB 40MG","","Select","Select",""],["","69315011710","FUROSEMIDE","TAB 40MG","","Select","Select",""],["","65862069705","VENLAFAXINE","CAP 150MG ER","","Select","Select",""],["","43598051030","ESOMEPRA MAG","CAP 40MG DR","","Select","Select",""],["","23155050210","HYDROXYZ HCL","TAB 50MG","","Select","Select",""],["","185041505","BUPROPION ","TAB 150MG SR","56","Select","Select",""],["","88221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","8","Select","Select",""],["","68382009201","CARVEDILOL ","TAB 3.125MG","56","Select","Select",""],["","168005415","NYSTATIN ","CRE 100000","15","Select","Select",""],["","27808003503","HYDROCO\/APAP ","TAB 5-325MG","15","Select","Select",""],["","8290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","2143480","TRULICITY ","INJ 1.5\/0.5","4","Select","Select",""],["","69315011710","FUROSEMIDE ","TAB 40MG","28","Select","Select",""],["","60505257908","ATORVASTATIN ","TAB 20MG","28","Select","Select",""],["","43598051030","ESOMEPRA ","CAP 40MG DR","28","Select","Select",""],["","65862069705","VENLAFAXINE ","CAP 150MG ER","56","Select","Select",""],["","43547040710","CLONAZEPAM ","TAB 1MG","56","Select","Select",""],["","63402030630","LATUDA ","TAB 60MG","28","Select","Select",""],["","14539067505","HYDROXYZ ","CAP 50MG","84","Select","Select",""],["","00185061505","HYDROXYZ","50MG","84","Select","Select",""],["","00378668910","PANTOPRAZOLE","40MG","30","Select","Select",""],["","43598051030","ESOMEPRA","40MG DR","28","Select","Select",""],["","90166043154","PEN NEEDLES","32GX4MM","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":[[["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":""}]}]}