{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICIA A LETCHFORD","gend":1,"add":"PO BOX 26426","city":"RICHMOND ","state":"VA","zip":"23260-6426","dob":"1953-01-11","age":"","mstatus":"","insh":11018245,"cliId":"3UY6MX1RP59","pno":5404922301,"cno":5404922301,"email":"","ename":"","eno":"","pphy":"AMBROZ, CHELSEA ANN  ","ppno":5407720555,"pcpadd":"1906 Belleview Ave SE","pcpcity":"Roanoke  ","pcpstate":"VA","pcpzip":240141838,"pcpcounty":"","pcpid":"P0117406","pcpname":"CARILION FAMILY MEDICINE COLONIAL AVENUE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"161 TWINKLE AVE NW","madd2":"","madd3":"","mcity":"ROANOKE  ","mstate":"VA","mzip":"24012-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","Z79.4","Z00.00","D50.9","E78.5","J44.9","F25.9","R56.9","E03.9","I10","E66.01","E22.2","Z78.0","Z12.31","Z13.820","M15.0","J45.40","H91.90"],"date":["2021-11-19","2021-11-19","2021-08-20","2021-11-19","2021-11-19","2021-11-09","2021-11-19","2021-08-20","2021-11-19","2021-11-19","2021-08-20","2021-08-20","2021-09-14","2021-09-14","2021-09-14","2021-11-09","2021-11-19","2021-11-19"],"priorHcc":[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":[]},{"a":[]}]},{"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":[["","591292754","LEVALBUTEROL ","45\/ACT","45","Select","Select",""],["","42806015905","HYDROXYZ ","10MG","270","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","90","Select","Select",""],["","68382076010","METFORMIN ","1000MG","180","Select","Select",""],["","169643810","LEVEMIR ","FLEXTOUC","150","Select","Select",""],["","93727098","PRAVASTATIN ","80MG","90","Select","Select",""],["","169406013","VICTOZA ","18MG\/3ML","27","Select","Select",""],["","65862022801","LAMOTRIGINE ","100MG","180","Select","Select",""],["","00378181510","LEVOTHYROXIN ","150MCG","90","Select","Select",""],["","00169185189","NOVOFINE ","32GX6MM","300","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","15","Select","Select",""],["","00597015330","JARDIANCE ","25MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","30.6","Select","Select",""],["","00169185189","NOVOFINE","32GX6MM","300","Select","Select",""],["","00169633910","NOVOLOG","FLEXPEN","15","Select","Select",""],["","00169643810","LEVEMIR","FLEXTOUC","150","Select","Select",""],["","65862022801","LAMOTRIGINE","100MG","180","Select","Select",""],["","00591292754","LEVALBUTEROL","45\/ACT","45","Select","Select",""],["","42806015905","HYDROXYZ","10MG","270","Select","Select",""],["","68180098103","LISINOPRIL","20MG","180","Select","Select",""],["","65862057490","MONTELUKAST","10MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","90","Select","Select",""],["","68382076010","METFORMIN","1000MG","180","Select","Select",""],["","00093727098","PRAVASTATIN","80MG","90","Select","Select",""],["","00378181710","LEVOTHYROXIN","175MCG","90","Select","Select",""],["","23155000101","HYDRALAZINE","10MG","270","Select","Select",""],["","00169406013","VICTOZA","18MG\/3ML","27","Select","Select",""],["","00597015330","JARDIANCE","25MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","30.6","Select","Select",""],["","51991074890","DULOXETINE","60MG","90","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","99073013001","FREESTYLE MIS LANCETS","LANCETS","200","Select","Select",""],["","99073012101","FREESTYLE TES","","100","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","51991074890","DULOXETINE ","CAP 60MG","90","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","180","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","23155000101","HYDRALAZINE ","TAB 10MG","270","Select","Select",""],["","99073012101","FREESTYLE    TES","TES ","100","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","200","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","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":""}]}]}