{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL L LINVILLE","gend":0,"add":"3029 SCENIC RD ","city":"FRIES ","state":"VA","zip":"24330-9998","dob":"1978-02-11","age":"","mstatus":"","insh":11018565,"cliId":"7MT6UN0JA53","pno":2767442269,"cno":2767442269,"email":"","ename":"","eno":"","pphy":"LLAVORE, JOANNE","ppno":5409817000,"pcpadd":"3369 Colonial Ave SW","pcpcity":"Roanoke  ","pcpstate":"VA","pcpzip":240183739,"pcpcounty":"","pcpid":"P0162873","pcpname":"CARILION MEDICAL ASSOCIATES INTERNAL MEDICINE GALA","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"3029 SCENIC RD ","madd2":"","madd3":"","mcity":"FRIES ","mstate":"VA","mzip":"24330-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.0","D47.3","R74.01","K76.0","Z86.39","Z86.79","Z86.59","E11.9"],"date":["2021-09-21","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-09-28"],"priorHcc":[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":[["","55111016830","OLANZAPINE","20MG","30","Select","Select",""],["","70436001102","BUPROPN","300MG XL","30","Select","Select",""],["","00115552210","FENOFIBRATE","160MG","90","Select","Select",""],["","43547034909","PAROXETINE","30MG","60","Select","Select",""],["","00591024101","LORAZEPAM","1MG","60","Select","Select",""],["","70436001102","BUPROPN ","TAB 300MG XL","30","Select","Select",""],["","00591024101","LORAZEPAM ","TAB 1MG","60","Select","Select",""],["","55111016830","OLANZAPINE ","TAB 20MG","30","Select","Select",""],["","00115552210","FENOFIBRATE ","TAB 160MG","90","Select","Select",""],["","43547034909","PAROXETINE ","TAB 30MG","60","Select","Select",""],["","00006027731","JANUVIA ","TAB 100MG","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","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":""}]}]}