{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SARA   A HARDY","gend":1,"add":"135 FALCON LN","city":"ROCKY MOUNT","state":"VA","zip":"24151-9998","dob":"1943-07-24","age":"","mstatus":"","insh":"900035735*01","cliId":"4T92QG2UD29","pno":"540\/334-1105","cno":"540\/334-1105","email":"","ename":"","eno":"","pphy":"MARTIN, PAULA DO","ppno":"540\/334-5511","pcpadd":"22890 VIRGIL GOODE HIGHWAY","pcpcity":"BOONES MILL","pcpstate":"VA","pcpzip":24065,"pcpcounty":"","pcpid":147705,"pcpname":"Carilion Family & Internal Medicine Boones Mill","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/334-3174","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z13.820","M85.89","R39.81","J44.9","J41.8","I10.","E78.2","R60.0","M85.80","E78.5","Z00.00","J42.","M81.0","E66.01","Z68.41","Z78.0","M85.88","E87.5"],"date":["2020-01-20","2020-01-20","2020-10-24","2021-09-30","2021-05-10","2021-05-10","2021-05-10","2020-10-20","2020-03-30","2020-10-20","2020-10-20","2019-09-30","2021-05-10","2021-05-10","2021-05-10","2020-01-20","2020-10-20","2021-06-18"],"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":[["","43547040111","FUROSEMIDE","TAB 20MG","180","Select","Select",""],["","69097022416","ALENDRONATE","TAB 70MG","12","Select","Select",""],["","832532411","POT CL MICRO","TAB 10MEQ ER","-90","Select","Select",""],["","68645055354","LISINOPRIL","TAB 20MG","90","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","173087310","INCRUSE ELPT","INH 62.5MCG","90","Select","Select",""],["","186037020","SYMBICORT","AER 160-4.5","-31","Select","Select",""],["","50111078810","AZITHROMYCIN","TAB 500MG","3","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","68645056854","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","93317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","43386091510","POT CHLORIDE","TAB 10MEQ ER","-90","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","14","Select","Select",""],["","832532411","POTASSIUM CHLORIDE ER","","90","Select","Select",""],["","68645056854","ATORVASTATIN CALCIUM ","","90","Select","Select",""],["","173087310","INCRUSE ELLIPTA ","","90","Select","Select",""],["","186037020","SYMBICORT ","","31","Select","Select",""],["","69097022416","ALENDRONATE SODIUM ","","12","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","","18","Select","Select",""],["","310737020","BUDESONIDE\/FORMOTEROL FUMARATE DIHYDRATE","","31","Select","Select",""],["","69097022416","ALENDRONATE SODIUM","","12","Select","Select",""],["","00173087310","INCRUSE ELLIPTA","","90","Select","Select",""],["","68645056854","ATORVASTATIN CALCIUM","","90","Select","Select",""],["","00832532410","POTASSIUM CHLORIDE ER                                                 ","TAB 10MEQ ER","90","Select","Select",""],["","00173068220","VENTOLIN HFA                                                          ","AER ","18","Select","Select",""],["","50111078810","AZITHROMYCIN                                                          ","TAB 500MG","3","Select","Select",""],["","00186037020","SYMBICORT                                                             ","AER 160-4.5","-31","Select","Select",""],["","68645055354","LISINOPRIL                                                            ","TAB 20MG","90","Select","Select",""],["","59310057922","PROAIR HFA                                                            ","AER ","8","Select","Select",""],["","00173087310","INCRUSE ELLIPTA                                                       ","INH 62.5MCG","90","Select","Select",""],["","68645056854","ATORVASTATIN CALCIUM                                                  ","TAB 40MG","90","Select","Select",""],["","69097022416","ALENDRONATE SODIUM                                                    ","TAB 70MG","12","Select","Select",""],["","00310737020","BUDESONIDE\/FORMOTEROL FUMARATE DIHYDRATE                              ","AER 160-4.5","31","Select","Select",""],["","43547040111","FUROSEMIDE                                                            ","TAB 20MG","135","Select","Select",""],["","59746017509","PREDNISONE                                                            ","TAB 20MG","14","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA                                                 ","AER HFA","54","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","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","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":""}]}]}