{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HAZEL   M KNIGHT","gend":1,"add":"171   LANE STREET                                           ","city":"PEARISBURG                    ","state":"VA","zip":"24134-2466","dob":"1950-10-02","age":"","mstatus":"","insh":10054736,"cliId":"","pno":5409210010,"cno":"","email":"","ename":"","eno":"","pphy":"DEVEREAUX, ROBERT                                           ","ppno":"","pcpadd":"430 Boxwood Ln,SUITE 801","pcpcity":"Pearisburg                    ","pcpstate":"VA","pcpzip":241341168,"pcpcounty":"","pcpid":"P9058429","pcpname":"CARILION CLINIC FAMILY MEDICINE GILES RURAL HEALTH","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"LOT B                                                       ","add3":"","madd1":"171   LANE STREET                                           ","madd2":"LOT B                                                       ","madd3":"","mcity":"PEARISBURG                    ","mstate":"VA","mzip":"24134-2466","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.3","E11.9","I10","K58.9","K52.9","F33.42","Z12.31","R51","M81.0","K21.9","E78.00","C50.411","Z17.0","Z23","Z79.899","M79.662","W19.XXXA","R07.89","R55","M25.561","M25.562","R07.9","M79.602","Z85.3","H54.8","Z79.4","Z11.59","Z00.00","I95.1","M54.32","F32.9","H35.30","Z79.82","R94.31","R06.89","I51.89","I50.22","I51.7","R94.39","I31.3","M54.31","I11.0","I50.9","I50.813","E11.65","I50.89","R60.1","R06.02","Z90.11","I50.32","R40.0","R35.1","R10.9","J30.1","N28.89","Z90.49","E78.5","E53.8","D64.9","Z12.83","E66.9","N64.89","R92.8","L82.1","L81.4","L57.0","N63.20","F31.75","M25.552","S79.912A","W01.0XXA","Y93.E1","Y92.9","Z85.89","D50.8","F25.1","M54.50","F20.9"],"date":["2021-11-21","2021-11-17","2021-11-17","2019-04-05","2019-04-05","2019-04-05","2021-08-25","2019-07-18","2020-06-18","2021-03-05","2020-07-23","2020-07-10","2020-07-10","2021-09-09","2021-11-08","2020-01-01","2021-11-08","2020-05-15","2020-01-10","2020-01-01","2020-01-01","2020-04-28","2020-01-01","2020-06-24","2020-06-18","2020-06-18","2020-01-10","2021-03-05","2020-03-12","2020-05-01","2020-04-27","2020-04-27","2021-11-08","2020-06-18","2020-04-27","2020-04-28","2020-05-01","2020-05-06","2020-05-06","2020-05-06","2020-05-15","2021-11-08","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-06-24","2021-11-08","2020-07-23","2020-07-23","2021-11-08","2020-09-09","2020-09-18","2020-09-18","2021-09-09","2021-09-09","2021-09-29","2021-09-09","2021-09-09","2021-09-10","2021-09-10","2021-09-15","2021-09-15","2021-09-15","2021-09-20","2021-11-18","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-17","2021-11-17","2021-11-18","2021-11-18"],"priorHcc":[null,null,null,"","","","","","","","","","","",null,"",null,"","","","","","","","","","","","","","","",null,"","","","","","","","",null,"","","","","","","",null,"","",null,"","","","","","","","","","","","","","",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":[["","68382011214","RISPERIDONE","0.25MG","56","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00093720210","PRAVASTATIN","40MG","28","Select","Select",""],["","00378003201","METOPROL","50MG","56","Select","Select",""],["","65862020399","LOSARTAN","100MG","28","Select","Select",""],["","65862052890","VENLAFAXINE","75MG ER","28","Select","Select",""],["","23155002305","BUSPIRONE","5MG","56","Select","Select",""],["","51991064405","OMEPRAZOLE","40MG","56","Select","Select",""],["","50111032701","HYDRALAZINE","25MG","60","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","21","Select","Select",""],["","64980030310","CHLORTHALID","25MG","28","Select","Select",""],["","10006073043","VITAMIN","1000MCG","28","Select","Select",""],["","59746021601","SPIRONOLACT","25MG","90","Select","Select",""],["","00904404073","ASPIRIN","81MG","30","Select","Select",""],["","00054429931","FUROSEMIDE","40MG","90","Select","Select",""],["","00832532411","POT CL MICRO","10MEQ ER","30","Select","Select",""],["","80777027398","MODERNA","COVID-19","0.5","Select","Select",""],["","59762330403","NITROGLYCERN","0.4MG","25","Select","Select",""],["","10006070050","MELATONIN","3MG","56","Select","Select",""],["","68382011214","RISPERIDONE ","TAB 0.25MG","56","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00093720210","PRAVASTATIN ","TAB 40MG","28","Select","Select",""],["","00378003201","METOPROL ","TAB 50MG","56","Select","Select",""],["","65862020399","LOSARTAN ","TAB 100MG","28","Select","Select",""],["","65862052890","VENLAFAXINE ","CAP 75MG ER","28","Select","Select",""],["","23155002305","BUSPIRONE ","TAB 5MG","56","Select","Select",""],["","51991064405","OMEPRAZOLE ","CAP 40MG","56","Select","Select",""],["","00904759180","FEROSUL ","TAB 325MG","56","Select","Select",""],["","43547040211","FUROSEMIDE ","TAB 40MG","90","Select","Select",""],["","50111032701","HYDRALAZINE ","TAB 25MG","60","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","64980030310","CHLORTHALID ","TAB 25MG","28","Select","Select",""],["","10006073043","VITAMIN ","TAB 1000MCG","28","Select","Select",""],["","59746021601","SPIRONOLACT ","TAB 25MG","90","Select","Select",""],["","00904404073","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","00832532411","POT  CL MICRO","TAB 10MEQ ER","30","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0.5","Select","Select",""],["","59762330403","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","10006070050","MELATONIN ","TAB 3MG","56","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","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}