{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HARRIET   C MARTIN","gend":1,"add":"3347 PITTSFIELD AVENUE NW                                   ","city":"ROANOKE                       ","state":"VA","zip":"24017-2800","dob":"1951-12-17","age":"","mstatus":"","insh":10056529,"cliId":"","pno":5406829118,"cno":"","email":"","ename":"","eno":"","pphy":"JEREMIAH, MICHAEL P                                         ","ppno":"","pcpadd":"1314 Peters Creek Rd Nw","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240172500,"pcpcounty":"","pcpid":"P0117344","pcpname":"CARILION FAMILY MEDICINE ROANOKE SALEM","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"3347 PITTSFIELD AVENUE NW                                   ","madd2":"                                                            ","madd3":"","mcity":"ROANOKE                       ","mstate":"VA","mzip":"24017-2800","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","M25.569","E66.9","R39.81","R15.9","M62.81","Z71.3","Z71.89","Z79.891","R68.89","I10","G62.9","I51.7","M79.605","R60.0","M79.604","K59.00","J44.9","K21.9","I25.2","Z85.828","F17.210","Z79.82","M79.609","R06.02","J01.00","M54.5","Z23","L02.31","K61.0","L03.116","L03.317","R26.2","R51.9","K62.89","L03.315","K61.1","R52","F41.9","Z79.51","M25.561","M25.562","G89.29","E78.5","E55.9","R55","L03.311","K59.09","K64.4","Z12.11","M17.0","Z13.820","M17.12","M17.11"],"date":["2021-07-28","2019-11-01","2021-06-20","2021-07-10","2021-07-10","2021-07-10","2019-08-27","2019-08-27","2021-07-28","2019-11-01","2021-07-28","2019-07-22","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2019-11-01","2021-07-28","2021-01-15","2019-08-04","2019-08-04","2021-06-20","2019-08-04","2019-08-04","2019-08-04","2020-01-08","2021-01-15","2021-10-22","2021-07-13","2021-07-28","2021-07-28","2021-07-13","2021-06-20","2021-06-20","2021-06-20","2021-06-20","2021-06-20","2021-06-20","2021-07-28","2021-07-28","2021-07-13","2021-07-13","2021-07-13","2021-10-22","2021-10-22","2021-10-22","2021-10-22","2021-10-22","2021-10-22","2021-10-22","2021-11-22","2021-10-22","2021-11-08","2021-11-08"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","65862020390","LOSARTAN","100MG","30","Select","Select",""],["","13668001005","CITALOPRAM","20MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","30","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","60","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","30","Select","Select",""],["","68180072103","AMLODIPINE","10MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","59779027408","ASPIRIN","81MG","30","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","69097094312","GABAPENTIN","300MG","90","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","64380080307","RANITIDINE","150MG","60","Select","Select",""],["","59779019463","ACID","20MG","60","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","28","Select","Select",""],["","50428037837","CVS","8.6-50MG","60","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","10","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","31722070290","LOSARTAN ","TAB 100MG","30","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","30","Select","Select",""],["","13668001005","CITALOPRAM ","TAB 20MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","59779027408","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","00093742698","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","64380080307","RANITIDINE ","TAB 150MG","60","Select","Select",""],["","69097015807","MELOXICAM ","TAB 7.5MG","30","Select","Select",""],["","45802048678","DOCUSATE ","CAP 100MG","60","Select","Select",""],["","59779019463","ACID ","TAB 20MG","60","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","28","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","67618010760","SLOW-MAG ","TAB ","30","Select","Select",""],["","50428037837","CVS ","TAB 8.6-50MG","60","Select","Select",""],["","00093310905","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","10","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":""}]}]}