{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDA   J HORTON","gend":1,"add":"329   FIELDSTONE LANE                                       ","city":"BLACKSBURG                    ","state":"VA","zip":"24060-1180","dob":"1950-05-18","age":"","mstatus":"","insh":10055277,"cliId":"","pno":5405997464,"cno":5405997464,"email":"","ename":"","eno":"","pphy":"MELTON, RUSSELL W                                           ","ppno":"","pcpadd":"430 Boxwood Ln","pcpcity":"Pearisburg                    ","pcpstate":"VA","pcpzip":241341168,"pcpcounty":"","pcpid":"P0125206","pcpname":"CARILION CLINIC FAMILY MEDICINE GILES RURAL HEALTH","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT C                                                       ","add3":"","madd1":"329   FIELDSTONE LANE                                       ","madd2":"APT C                                                       ","madd3":"","mcity":"BLACKSBURG                    ","mstate":"VA","mzip":"24060-1180","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J43.8","J45.50","R09.02","M54.5","I10","E78.5","M81.0","J44.9","M19.90","K21.9","Z79.51","J40","R05","R09.81","R50.9","J45.51","Z99.81","G25.81","R47.9","Q35.9","Z12.31","D71","J84.10","I50.32","M25.511","G89.29","M19.011","M25.611","M54.12","J18.8","I11.0","J18.9","R06.2","R91.8","E78.1","J45.40","R06.09","N28.9","R00.0","R06.02","R42","R06.89","R30.0","R68.89","H90.5","E86.0","R55","I65.23","R26.81","H70.91","J30.9","N39.0","R51","R10.84","R11.0","J44.1","J06.9","J30.89","E78.00","K76.0","G47.36","K59.00","R47.89","Z82.5","K59.01","N30.00","L97.519","Z79.52","M79.601","M51.36","M51.37","M47.816","S39.92XA","M75.81","M75.41","X50.0XXA","M17.12","Z23","R73.9","R53.83","Z20.828","Z11.59","J01.00","B96.89","Z20.822","Z00.00","M79.621","M25.421","S52.121A","M25.521","W01.10XA","Y93.K1","Z87.891","S52.124A","J45.41","Z82.49","M79.641","J41.1","R06.00","S52.124D","J45.909","J82.83"],"date":["2021-10-26","2021-10-26","2021-10-26","2020-06-12","2021-10-21","2021-10-21","2021-10-21","2021-10-11","2019-02-01","2021-08-09","2021-09-02","2021-07-01","2021-09-02","2021-09-02","2019-05-09","2021-10-21","2021-10-21","2021-04-21","2020-02-17","2020-02-17","2021-05-17","2019-03-31","2019-03-31","2021-10-21","2020-06-04","2020-06-12","2020-04-20","2019-04-25","2019-04-25","2019-05-09","2021-06-05","2019-05-09","2021-06-29","2020-02-13","2021-06-05","2021-02-03","2019-10-17","2019-08-14","2021-02-17","2021-10-11","2021-04-18","2019-08-16","2019-09-23","2020-06-04","2019-10-11","2019-10-15","2019-10-17","2019-10-25","2019-10-25","2019-10-25","2020-02-17","2020-06-12","2020-01-26","2020-01-26","2020-01-26","2021-10-01","2020-02-13","2021-10-21","2020-02-13","2020-02-14","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-14","2020-03-31","2020-03-31","2020-03-31","2020-04-16","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2020-04-20","2020-05-20","2020-06-12","2020-07-21","2021-10-21","2020-12-04","2020-12-11","2020-12-11","2020-12-11","2021-03-05","2021-03-05","2021-09-02","2021-04-21","2021-05-30","2021-05-30","2021-05-30","2021-07-13","2021-05-30","2021-05-30","2021-05-30","2021-06-15","2021-06-05","2021-06-05","2021-06-15","2021-06-29","2021-06-29","2021-07-13","2021-10-11","2021-10-21"],"priorHcc":[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":[["","68001036103","MONTELUKAST","10MG","30","Select","Select",""],["","00406055201","OXYCODONE","5MG","10","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10.2","Select","Select",""],["","65862032904","ALENDRONATE","70MG","4","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10.2","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","76204020025","ALBUTEROL","0.08%","150","Select","Select",""],["","42858070101","THEOPHYLLINE","400MG ER","45","Select","Select",""],["","68462039610","OMEPRAZOLE","20MG","30","Select","Select",""],["","59746017509","PREDNISONE","20MG","8","Select","Select",""],["","00143980305","DOXYCYCL","100MG","14","Select","Select",""],["","65862064163","AZITHROMYCIN","250MG","6","Select","Select",""],["","64380080807","IBUPROFEN","600MG","20","Select","Select",""],["","65862001905","CEPHALEXIN","500MG","28","Select","Select",""],["","00591034705","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","10","Select","Select",""],["","29300012410","MELOXICAM","7.5MG","30","Select","Select",""],["","55111012701","CIPROFLOXACN","500MG","14","Select","Select",""],["","65862053750","LEVOFLOXACIN","500MG","7","Select","Select",""],["","68001036103","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","10","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","65862032904","ALENDRONATE ","TAB 70MG","4","Select","Select",""],["","00310737020","BUDES\/FORMOT ","AER 160-4.5","10.2","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","76204020025","ALBUTEROL ","NEB 0.00083","150","Select","Select",""],["","42858070101","THEOPHYLLINE ","TAB 400MG ER","45","Select","Select",""],["","68462039610","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","59746017310","PREDNISONE ","TAB 10MG","30","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","65862064163","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","20","Select","Select",""],["","65862001905","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","00591034705","HYDROCHLOROT ","CAP 12.5MG","30","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","10","Select","Select",""],["","29300012410","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","55111012701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","7","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":""}]}]}