{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROGER RIFFE","gend":0,"add":"362 LAKEWOOD ACRES DRIVE                                    ","city":"HARDY                         ","state":"VA","zip":"24101-2818","dob":"1975-02-22","age":"","mstatus":"","insh":10195553,"cliId":"","pno":5404206392,"cno":5404206392,"email":"","ename":"","eno":"","pphy":"PAGAN, ELVIS R                                              ","ppno":"","pcpadd":"615 McDowell Ave NW","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240161225,"pcpcounty":"","pcpid":"P0117426","pcpname":"CARILION CLINIC INTERNAL MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"362 LAKEWOOD ACRES DRIVE                                    ","madd2":"                                                            ","madd3":"","mcity":"HARDY                         ","mstate":"VA","mzip":"24101-2818","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R26.1","R26.89","R26.81","R29.6","M62.81","M54.5","M79.651","M79.652","M25.561","M54.2","R29.818","M79.671","R13.12","M54.16","G95.9","M54.14","Z01.818","M47.812","M51.24","M51.36","Z98.1","M51.14","G72.9","M47.892","M54.13","E03.9","L03.213","E78.2","G89.4","Z79.899","M54.12","R06.02","H90.3","H69.80","M54.42","M54.41","Z72.0","R06.83","Z87.891","J45.30","S62.609A","X58.XXXA","F17.290","J06.9","E01.0","J44.9","E06.3","K12.0","G47.10","R53.1","F43.22","F17.200","N52.9","G47.33"],"date":["2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-12-29","2020-02-04","2020-02-04","2020-02-04","2021-03-24","2020-02-04","2020-02-04","2020-02-06","2020-12-30","2020-10-12","2020-10-12","2020-09-12","2020-09-17","2020-09-17","2021-08-24","2020-12-29","2020-09-17","2020-09-17","2020-09-17","2020-09-17","2021-05-17","2020-10-13","2021-05-17","2020-12-30","2020-12-30","2020-12-30","2021-03-26","2021-02-11","2021-02-11","2021-02-17","2021-02-17","2021-02-17","2021-03-17","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-04-21","2021-05-20","2021-05-17","2021-09-07","2021-08-10","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-11-02","2021-09-29"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","00378180910","LEVOTHYROXIN","100MCG","30","Select","Select",""],["","00173069700","ADVAIR","500\/50","60","Select","Select",""],["","00000000000","","","150","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","68180071160","CEFDINIR","300MG","20","Select","Select",""],["","24208091055","ERYTHROMYCIN","OP","3.5","Select","Select",""],["","00093720198","PRAVASTATIN","20MG","30","Select","Select",""],["","69097014260","ALBUTEROL","HFA","6.7","Select","Select",""],["","00603533715","PREDNISONE","5MG","21","Select","Select",""],["","69097015907","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","00378181110","LEVOTHYROXIN ","TAB 112MCG","30","Select","Select",""],["","00173069700","ADVAIR ","AER 500\/50","60","Select","Select",""],["","70377002811","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","24208091055","ERYTHROMYCIN ","OIN OP","3.5","Select","Select",""],["","00093720198","PRAVASTATIN ","TAB 20MG","30","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","00603533715","PREDNISONE ","PAK 5MG","21","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","",""],["N\/A","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":""}]}]}