{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EVA G ELKINS","gend":1,"add":"956 MOOREHEAD AVENUE SE ","city":"ROANOKE  ","state":"VA","zip":"24013-9998","dob":"1964-01-30","age":"","mstatus":"","insh":11017348,"cliId":"7XP7YD0ER63","pno":5406328373,"cno":5407287875,"email":"","ename":"","eno":"","pphy":"JOHNSON, BRUCE E  ","ppno":5409817000,"pcpadd":"1906 Belleview Ave SE","pcpcity":"Roanoke  ","pcpstate":"VA","pcpzip":240141838,"pcpcounty":"","pcpid":"P0117745","pcpname":"CARILION ROANOKE MEMORIAL HOSPITALISTS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"956 MOOREHEAD AVENUE SE ","madd2":"","madd3":"","mcity":"ROANOKE  ","mstate":"VA","mzip":"24013-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D48.5","G89.28","Z79.899","M25.569","M54.2","L82.1","G56.01","M77.11","M79.601","R20.2","G56.21","M54.5","M54.16","Z79.891","Z51.81","G89.12","M54.17","M53.3","M48.061","M17.12","M51.16","R22.32","J44.9","F41.9","R53.83","F17.200","R68.2","R11.0","E55.9","Z12.2","R49.0","R25.2","K21.9","F17.210","R91.8","R91.1","I25.10","I25.84","J38.3","J38.1","G89.29","M54.50","M79.652","M47.816","M85.80","M43.16","Z01.818"],"date":["2021-02-02","2021-02-24","2021-02-24","2021-02-24","2021-11-15","2021-02-02","2021-03-30","2021-03-11","2021-03-29","2021-03-29","2021-03-30","2021-08-09","2021-04-21","2021-11-15","2021-05-28","2021-05-07","2021-08-09","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-05-20","2021-08-30","2021-08-30","2021-08-31","2021-10-11","2021-08-31","2021-08-30","2021-08-31","2021-09-13","2021-09-20","2021-08-30","2021-08-30","2021-09-20","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-20","2021-09-20","2021-10-11","2021-11-15","2021-10-11","2021-10-14","2021-10-14","2021-11-15","2021-11-27"],"priorHcc":["","","","",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":[["","43386035801","HYDROCO\/APAP","TAB 10-325MG","","Select","Select",""],["","832105410","BACLOFEN","TAB 10MG","","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","","Select","Select",""],["","16729020001","BUSPIRONE","TAB 5MG","","Select","Select",""],["","65862052405","GABAPENTIN","TAB 800MG","","Select","Select",""],["","57841130101","MOVANTIK","TAB 25MG","","Select","Select",""],["","43386035801","HYDROCO\/APAP ","TAB 10-325MG","120","Select","Select",""],["","832105410","BACLOFEN ","TAB 10MG","270","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","65862052405","GABAPENTIN ","TAB 800MG","360","Select","Select",""],["","16729020001","BUSPIRONE ","TAB 5MG","60","Select","Select",""],["","173088710","TRELEGY ","ELLIPTA","180","Select","Select",""],["","93317431","ALBUTEROL ","E","25.5","Select","Select",""],["","57841130101","MOVANTIK ","25MG","30","Select","Select",""],["","65162052110","PROMETHAZINE ","25MG","15","Select","Select",""],["","00173088710","TRELEGY","ELLIPTA","180","Select","Select",""],["","00093317431","ALBUTEROL","E","25.5","Select","Select",""],["","65162052110","PROMETHAZINE","25MG","15","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","90","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","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":[[["No","Select","",false,""],["No","Select","",false,""],["No","Select","",false,""],["Yes","Select","",false,""],["No","Select","",false,""],["No","Select","",false,""],["N\/A","Select","",false,""]]]},{"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":""}]}]}