{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER   L ARMSTRONG","gend":1,"add":"84   ARMSTRONG LANE                                         ","city":"DOE HILL                      ","state":"VA","zip":"24433-2342","dob":"1988-07-08","age":"","mstatus":"","insh":10051167,"cliId":"","pno":5403963322,"cno":5404142654,"email":"","ename":"","eno":"","pphy":"DEBELAK, JACOB P                                            ","ppno":"","pcpadd":"1906 Belleview Ave SE","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240141838,"pcpcounty":"","pcpid":"P0117745","pcpname":"CARILION ROANOKE MEMORIAL HOSPITALISTS","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"84   ARMSTRONG LANE                                         ","madd2":"                                                            ","madd3":"","mcity":"DOE HILL                      ","mstate":"VA","mzip":"24433-2342","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L20.84","Z79.899","Z01.419","Z11.51","G40.109","G40.802","L21.8","L85.3","N76.0","B96.89","B37.3","F44.5","G40.119","G40.89","G93.5","F15.10","Z23","R56.9","G40.909","F32.9","Z87.828","Z65.8","Z91.89","G40.219","D22.5","R05","H66.92","F43.20","L23.9","Z30.430","Z30.432","Z32.02","N89.8","N30.00","F41.9","F41.1","L29.9"],"date":["2020-03-09","2019-04-17","2019-04-01","2019-04-01","2021-10-01","2020-02-13","2019-04-17","2019-06-28","2020-02-07","2020-02-07","2020-02-07","2020-02-17","2020-10-30","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-03-12","2021-09-16","2020-02-14","2020-02-14","2020-02-14","2020-02-17","2020-03-09","2020-03-12","2020-03-12","2021-11-22","2020-05-27","2020-06-05","2020-06-05","2020-06-05","2020-11-18","2020-11-04","2021-07-06","2021-09-16","2021-10-14"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","63402020230","APTIOM","200MG","150","Select","Select",""],["","00131247935","VIMPAT","150MG","90","Select","Select",""],["","69315090410","LORAZEPAM","0.5MG","20","Select","Select",""],["","00143993905","AMOXICILLIN","500MG","20","Select","Select",""],["","00904665760","BENZONATATE","100MG","30","Select","Select",""],["","13668000905","CITALOPRAM","10MG","30","Select","Select",""],["","47781030301","NITROFURANTN","100MG","10","Select","Select",""],["","87651030152","AZO","95MG","12","Select","Select",""],["","69097083312","SERTRALINE","25MG","30","Select","Select",""],["","68001036500","METRONIDAZOL","500MG","14","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","68462010230","FLUCONAZOLE","100MG","3","Select","Select",""],["","49281042050","FLUZONE","2020-21","0.5","Select","Select",""],["","63402020230","APTIOM ","TAB 200MG","150","Select","Select",""],["","00131247935","VIMPAT ","TAB 150MG","90","Select","Select",""],["","69315090410","LORAZEPAM ","TAB 0.5MG","20","Select","Select",""],["","00143993905","AMOXICILLIN ","CAP 500MG","20","Select","Select",""],["","00904665760","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","13668000905","CITALOPRAM ","TAB 10MG","30","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","87651030152","AZO ","TAB 95MG","12","Select","Select",""],["","00472024260","PERMETHRIN ","CRE 0.05","60","Select","Select",""],["","16714008310","HYDROXYZ ","TAB 50MG","30","Select","Select",""],["","69097083312","SERTRALINE ","TAB 25MG","30","Select","Select",""],["","71699020128","XCOPRI ","PAK 12.5-25","28","Select","Select",""],["","68001036500","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","68462010230","FLUCONAZOLE ","TAB 100MG","3","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0.5","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","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}