{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROLYN   F HUNT","gend":1,"add":"511 KING GEORGE AVE SW","city":"ROANOKE","state":"VA","zip":"24016-9998","dob":"1943-03-15","age":"","mstatus":"","insh":"900037204*01","cliId":"3K91U83UT11","pno":"540\/685-3486","cno":"540\/685-3486","email":"","ename":"","eno":"","pphy":"LEONG, APOLLO Y MD","ppno":"540\/772-8950","pcpadd":"1818 ELECTRIC RD","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24018,"pcpcounty":"","pcpid":147719,"pcpname":"Carilion Clinic Primary Care Associates Salem","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/774-0146","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","N18.3","R73.03","E03.9","Z79.899","Z23.","I25.10","Z95.5","I12.9","Z00.00","R11.0","H53.9","E78.2","N18.30","I20.0","Z74.3","K22.2","K44.9","K21.9","N18.31"],"date":["2021-08-10","2020-05-26","2020-05-26","2021-06-11","2021-08-10","2020-11-25","2020-08-31","2020-08-31","2020-05-04","2020-11-25","2020-11-25","2020-11-25","2021-06-11","2021-06-11","2021-08-04","2021-08-04","2021-08-10","2021-08-10","2021-08-10","2021-08-10"],"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":[["","69238117209","DOXEPIN HCL","CAP 75MG","90","Select","Select",""],["","45963067611","METOPROLOL","TAB 50MG ER","90","Select","Select",""],["","31722088390","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","68382056501","METOPROL SUC","TAB 50MG ER","-90","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","93007401","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","68382012205","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","93720298","PRAVASTATIN","TAB 40MG","90","Select","Select",""],["","62037083101","METOPROLOL SUCCINATE ER","","30","Select","Select",""],["","65862056090","PANTOPRAZOLE SODIUM","","90","Select","Select",""],["","68462015713","ONDANSETRON ODT ","","30","Select","Select",""],["","65862016001","ZOLPIDEM TARTRATE","","30","Select","Select",""],["","68382012205","AMLODIPINE BESYLATE","","90","Select","Select",""],["","31722088390","ROSUVASTATIN CALCIUM ","","90","Select","Select",""],["","93720298","PRAVASTATIN SODIUM ","","-90","Select","Select",""],["","68462015713","ONDANSETRON ODT","","30","Select","Select",""],["","31722088390","ROSUVASTATIN CALCIUM","","90","Select","Select",""],["","00093720298","PRAVASTATIN SODIUM","","90","Select","Select",""],["","65862016001","ZOLPIDEM TARTRATE                                                     ","TAB 10MG","30","Select","Select",""],["","62037083101","METOPROLOL SUCCINATE ER                                               ","TAB 50MG ER","-30","Select","Select",""],["","31722088390","ROSUVASTATIN CALCIUM                                                  ","TAB 10MG","-90","Select","Select",""],["","69238117209","DOXEPIN HCL                                                           ","CAP 75MG","60","Select","Select",""],["","57237007710","ONDANSETRON ODT                                                       ","TAB 4MG ODT","30","Select","Select",""],["","68180098003","LISINOPRIL                                                            ","TAB 10MG","90","Select","Select",""],["","65862056090","PANTOPRAZOLE SODIUM                                                   ","TAB 40MG","90","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE                                                   ","TAB 5MG","90","Select","Select",""],["","00093720298","PRAVASTATIN SODIUM                                                    ","TAB 40MG","90","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","",""],["Yes","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":""}]}]}