{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARGARET S CONNER","gend":1,"add":"325 LONG STREET APT 11","city":"DUBLIN","state":"VA","zip":240849999,"dob":"1945-10-21","age":"","mstatus":"","insh":11017251,"cliId":"1VY4D70PC79","pno":5402007067,"cno":"","email":"","ename":"","eno":"","pphy":"KESSLER, JEREMY","ppno":5407728670,"pcpadd":"4035 Electric Rd Ste A","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240188449,"pcpcounty":"","pcpid":"P0154561","pcpname":"CARILION CLINIC FAMILY MEDICINE DUBLIN","plan":"VPHP - VIRGINIA PREMIER","program":"Medicare","lob":"DSNP","region":"ROANOKE\/ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["I10","K21.9","K50.90","I67.9","I69.354","S82.402S","G35","R29.6","R26.89","I48.0","I25.10","J44.9","F17.210","M47.26","M15.0","M54.5","R42","H81.10","K75.81","N39.0","S82.442D","S93.402D","M17.12","R41.0","R39.15","R20.8","M25.551","M47.816","M54.16","R41.82","E78.5","Z79.82","Z86.73","E55.9","Z51.81","R91.1","M51.26","F41.9","B37.2","M51.36","Z68.25","E66.3","R30.9","J01.90","F41.8","M15.9","R44.3","R53.1","F17.200","K74.60","E86.0","R44.1","R19.7","F33.9","Z87.440","H25.13","H25.11"],"date":["2021-06-14","2021-06-14","2021-01-01","2021-05-19","2021-06-14","2021-05-15","2021-06-14","2021-05-15","2021-05-15","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2021-05-15","2021-06-14","2021-06-14","2021-06-28","2021-03-03","2021-03-03","2021-03-03","2021-03-06","2021-03-06","2021-03-06","2021-03-20","2021-03-20","2021-03-20","2021-05-19","2021-06-28","2021-05-17","2021-05-19","2021-06-28","2021-03-29","2021-03-29","2021-04-23","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-06-22","2021-04-23","2021-04-23","2021-04-23","2021-05-17","2021-05-17","2021-05-17","2021-05-19","2021-05-19","2021-05-19","2021-06-07","2021-06-14","2021-06-14","2021-06-08","2021-06-08"],"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":[["","64380080707","IBUPROFEN","TAB 800MG","","Select","Select",""],["","316022115","NYSTATIN","CRE 100000","","Select","Select",""],["","168000215","TRIAMCINOLON","CRE 0.005","","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","","Select","Select",""],["","378668999","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","406012305","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","","Select","Select",""],["","93100301","BUSPIRONE","TAB 15MG","","Select","Select",""],["","53885004601","ONETOUCH","KIT ULTRA 2","","Select","Select",""],["","62559039150","VANCOMYCIN","CAP 250MG","","Select","Select",""],["","527133001","BACLOFEN","TAB 10MG","","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","68382080601","TRAZODONE","TAB 100MG","","Select","Select",""],["","143992801","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","53746051105","SPIRONOLACT","TAB 25MG","","Select","Select",""],["","16714061306","SERTRALINE","TAB 100MG","","Select","Select",""],["","65862056099","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","168000215","TRIAMCINOLON ","CRE 0.005","150","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","60","Select","Select",""],["","93100301","BUSPIRONE ","TAB 15MG","60","Select","Select",""],["","316022115","NYSTATIN ","CRE 100000","15","Select","Select",""],["","53746051105","SPIRONOLACT ","TAB 25MG","90","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","240","Select","Select",""],["","58657067601","CIPROFLOXACN ","TAB 500MG","20","Select","Select",""],["","54429731","FUROSEMIDE ","TAB 20MG","90","Select","Select",""],["","406012310","HYDROCO\/APAP ","TAB 5-325MG","30","Select","Select",""],["","68180016713","VANCOMYCIN ","CAP 250MG","28","Select","Select",""],["","53885000810","ONETOUCH ","MIS PLUS 33G","100","Select","Select",""],["","527133001","BACLOFEN ","TAB 10MG","270","Select","Select",""],["","60505265401","TRAZODONE ","TAB 100MG","90","Select","Select",""],["","10702000350","PROMETHAZINE ","TAB 25MG","30","Select","Select",""],["","16714061306","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","76204020025","ALBUTEROL ","NEB 0.00083","225","Select","Select",""],["","65162010250","GABAPENTIN ","CAP 300MG","120","Select","Select",""],["","52817036100","METOPROL ","TAB 50MG","30","Select","Select",""],["","27241009803","DULOXETINE ","30MG","30","Select","Select",""],["","59762219803","AZITHROMYCIN ","250MG","6","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","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}