{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISA   K FIELDS","gend":1,"add":"170   RIDGE ROAD                                            ","city":"TROUTVILLE                    ","state":"VA","zip":"24175-6366","dob":"1965-11-04","age":"","mstatus":"","insh":10055270,"cliId":"","pno":5406132686,"cno":5406132686,"email":"","ename":"","eno":"","pphy":"SCHMIDT-DALTON, TARIN ANN                                   ","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":"APT B                                                       ","add3":"","madd1":"170   RIDGE ROAD                                            ","madd2":"APT B                                                       ","madd3":"","mcity":"TROUTVILLE                    ","mstate":"VA","mzip":"24175-6366","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I25.810","I10","R19.00","N63.20","Z23","R91.1","I77.4","Z87.898","R06.02","R60.1","I50.32","I50.9","J44.9","Z79.899","Z79.82","N60.02","Z86.018","N63.21","R10.13","R60.0","R19.4","R19.5","R22.0","R22.2","Z98.890","I21.09","K21.9","I25.10","E78.5","R09.89","E65","R51","D75.89","Z12.11","E87.6","R06.00","Z87.891","R29.6","Z01.42","Z01.419","K43.2","Z01.818","R06.09","K42.9","M79.18","K13.0","Z95.1","Z01.810","R52","R29.898","I73.9","G57.03","M54.5","M48.062","G89.29","F51.01","R20.2","B37.0"],"date":["2019-04-11","2021-05-05","2019-04-11","2019-04-11","2020-09-03","2019-04-11","2019-04-11","2019-04-11","2020-06-04","2019-08-10","2019-08-10","2019-08-10","2021-05-05","2019-08-10","2019-08-10","2019-08-28","2019-08-28","2019-08-28","2019-11-14","2020-06-04","2019-08-28","2019-08-28","2019-08-28","2019-08-28","2019-08-28","2019-11-14","2019-11-14","2021-05-05","2020-10-28","2019-11-14","2019-11-21","2019-11-21","2019-11-21","2020-09-03","2019-12-19","2020-06-04","2020-09-10","2020-06-04","2020-09-03","2020-09-03","2020-10-28","2020-09-05","2020-09-10","2020-09-21","2020-10-01","2020-10-01","2020-10-28","2020-10-28","2020-11-03","2020-11-03","2020-11-30","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2021-05-05","2021-05-05","2021-05-05"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","68382009205","CARVEDILOL","3.125MG","60","Select","Select",""],["","00904782236","CLOTRIMAZOLE","1%","15","Select","Select",""],["","57237001930","DULOXETINE","60MG","90","Select","Select",""],["","31722070090","LOSARTAN","25MG","60","Select","Select",""],["","68645049554","ATORVASTATIN","80MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG","90","Select","Select",""],["","69097014260","ALBUTEROL","HFA","6.7","Select","Select",""],["","67877019705","AMLODIPINE","2.5MG","30","Select","Select",""],["","16729017217","AMITRIPTYLIN","25MG","30","Select","Select",""],["","00527512170","NYSTATIN","100000","60","Select","Select",""],["","43547040111","FUROSEMIDE","20MG","90","Select","Select",""],["","68462063945","NITROGLYCERN","0.4MG","25","Select","Select",""],["","69315012710","FOLIC","1000MCG","90","Select","Select",""],["","59676058015","JANSSEN","COVID-19","0.5","Select","Select",""],["","00186037220","SYMBICORT","80-4.5","10.2","Select","Select",""],["","68382009205","CARVEDILOL ","TAB 3.125MG","60","Select","Select",""],["","00904782236","CLOTRIMAZOLE ","CRE 0.01","15","Select","Select",""],["","57237001930","DULOXETINE ","CAP 60MG","90","Select","Select",""],["","31722070090","LOSARTAN ","TAB 25MG","60","Select","Select",""],["","68645049554","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","67877019705","AMLODIPINE ","TAB 2.5MG","30","Select","Select",""],["","16729017217","AMITRIPTYLIN ","TAB 25MG","30","Select","Select",""],["","00527512170","NYSTATIN ","SUS 100000","60","Select","Select",""],["","43547040111","FUROSEMIDE ","TAB 20MG","90","Select","Select",""],["","68462063945","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","90","Select","Select",""],["","59676058015","JANSSEN ","INJ COVID-19","0.5","Select","Select",""],["","00186037220","SYMBICORT ","AER 80-4.5","10.2","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","",""],["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":""}]}]}