{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TYRONE   K CHRISTIAN","gend":0,"add":"2108   KING CHARLES AVENUE SE                               ","city":"ROANOKE                       ","state":"VA","zip":"24014-3716","dob":"1968-01-16","age":"","mstatus":"","insh":10054721,"cliId":"","pno":5405129778,"cno":2767304643,"email":"","ename":"","eno":"","pphy":"CHEN, ERIC HONG WEN                                         ","ppno":"","pcpadd":"2145 Mount Pleasant Blvd SE","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240143632,"pcpcounty":"","pcpid":"P0117344","pcpname":"CARILION FAMILY MEDICINE ROANOKE SALEM","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"2108   KING CHARLES AVENUE SE                               ","madd2":"                                                            ","madd3":"","mcity":"ROANOKE                       ","mstate":"VA","mzip":"24014-3716","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.81","S62.360A","S69.91XA","M65.30","J44.9","S62.390A","S62.300A","S62.300D","S62.390D","Y09","F25.1","F51.01","T78.3XXA","Z91.09","Z72.0","F41.1","Z01.818","F17.210","R30.0","N30.90","R35.0","F10.10","F41.8","F10.20","K21.01","F17.211","G89.29","M25.511","M24.811","S43.431A","M19.011","M25.411","M67.813"],"date":["2021-03-29","2019-03-04","2019-03-04","2019-03-04","2021-03-29","2019-03-04","2019-03-06","2019-03-27","2019-03-27","2019-03-27","2020-07-01","2019-09-18","2019-09-18","2021-03-29","2021-03-29","2021-09-20","2020-05-26","2020-05-29","2020-06-01","2020-06-01","2020-06-01","2021-04-05","2021-01-21","2021-09-20","2021-03-29","2021-09-20","2021-09-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","00186037220","SYMBICORT","80-4.5","10.2","Select","Select",""],["","59779048471","PAIN","500MG","90","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","51991074890","DULOXETINE","60MG","30","Select","Select",""],["","13107008405","LORAZEPAM","1MG","10","Select","Select",""],["","45802042578","FEXOFENADINE","60MG","60","Select","Select",""],["","00904673080","ACETAMIN","500MG","90","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","65862048901","QUETIAPINE","25MG","60","Select","Select",""],["","10370010150","BUPROPN","150MG XL","30","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","49483060350","IBUPROFEN","600MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","28","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","4","Select","Select",""],["","00186037220","SYMBICORT ","AER 80-4.5","10.2","Select","Select",""],["","59779048471","PAIN ","TAB 500MG","90","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","51991074890","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","13107008405","LORAZEPAM ","TAB 1MG","10","Select","Select",""],["","45802042578","FEXOFENADINE ","TAB 60MG","60","Select","Select",""],["","00904673080","ACETAMIN ","TAB 500MG","90","Select","Select",""],["","65862049001","QUETIAPINE ","TAB 50MG","90","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","49483060350","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","10370010150","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","4","Select","Select",""],["","49483034150","ACETAMINOPHN ","TAB 500MG","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","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}