{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HABSATOU SALIFOU ADAM","gend":1,"add":"2814 GREEN RIDGE ROAD                                       ","city":"ROANOKE                       ","state":"VA","zip":"24019-3400","dob":"1984-04-21","age":"","mstatus":"","insh":10204620,"cliId":"","pno":5402784827,"cno":5402784827,"email":"","ename":"","eno":"","pphy":"SPEAKER, MARCUS                                             ","ppno":"","pcpadd":"2145 Mount Pleasant Blvd SE,Ste 100","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240143632,"pcpcounty":"","pcpid":"P0117344","pcpname":"CARILION FAMILY MEDICINE ROANOKE SALEM","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"2814 GREEN RIDGE ROAD                                       ","madd2":"                                                            ","madd3":"","mcity":"ROANOKE                       ","mstate":"VA","mzip":"24019-3400","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23","Z00.00","O34.219","J45.20","O23.40","O26.893","M54.5","O99.513","J45.909","Z3A.35","O26.899","M79.18","Z34.90","Z39.1","Z34.82","Z34.83","O34.211","O23.43","Z37.0","Z3A.39","O99.52","K66.0","N85.6","Z90.79","Z88.6","O99.824","O09.523","O09.43","D62","N39.0","B95.1","Z30.014","Z30.09","N72","Z12.4","R87.610","Z32.02","Z86.19","Z87.59","Z11.3","T78.1XXD","L20.9","J30.1","N93.9","R35.0","Z72.51","L30.9","Z91.09","I83.93","L81.1","Z91.89"],"date":["2021-06-18","2019-10-18","2019-11-20","2021-06-18","2019-11-26","2019-11-20","2019-11-20","2019-11-20","2019-12-12","2019-11-20","2019-11-20","2019-11-20","2019-11-26","2019-11-27","2019-11-27","2019-11-27","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2020-01-27","2020-02-19","2020-02-19","2020-05-11","2021-03-04","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-06-08","2021-06-18","2021-06-17","2021-03-04","2021-03-04","2021-03-04","2021-03-17","2021-03-17","2021-03-30","2021-06-02","2021-06-25"],"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":[["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","33342032915","TRIAMCINOLON","0.10%","15","Select","Select",""],["","00093770198","LEVOCETIRIZI","5MG","30","Select","Select",""],["","50428246181","MAGNESIUM","250MG","30","Select","Select",""],["","43386009660","CLOBETASOL","0.05%","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","65862057490","MONTELUKAST","10MG","90","Select","Select",""],["","16729042210","TACROLIMUS","0.10%","30","Select","Select",""],["","14539067401","HYDROXYZ","25MG","30","Select","Select",""],["","59779042553","ALLERGY","60MG","24","Select","Select",""],["","66993006002","ATOVAQ\/PROGU","250-100","30","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","33342032915","TRIAMCINOLON ","CRE 0.001","15","Select","Select",""],["","00093770198","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","50428246181","MAGNESIUM ","TAB 250MG","30","Select","Select",""],["","43386009660","CLOBETASOL ","OIN 0.0005","30","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","65862057490","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","16729042210","TACROLIMUS ","OIN 0.001","30","Select","Select",""],["","14539067401","HYDROXYZ ","CAP 25MG","30","Select","Select",""],["","59779042553","ALLERGY ","TAB 60MG","24","Select","Select",""],["","66993006002","ATOVAQ\/PROGU ","TAB 250-100","30","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","",""],["No","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":""}]}]}