{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LILLIAN   M TAYLOR","gend":1,"add":"525 SOUTH 12TH APT A1","city":"WYTHEVILLE","state":"VA","zip":"24382-9998","dob":"1929-01-12","age":"","mstatus":"","insh":"900042430*01","cliId":"5QH9MG8JT48","pno":"276\/228-5934","cno":"276\/228-5934","email":"","ename":"","eno":"","pphy":"TOMIAK, WILLIAM M MD","ppno":"276\/228-8686","pcpadd":"1375 W RIDGE ROAD","pcpcity":"WYTHEVILLE","pcpstate":"VA","pcpzip":24382,"pcpcounty":"","pcpid":147705,"pcpname":"Carilion Family Medicine Wytheville","plan":"OHP","program":"MEDICARE","lob":"MA-NON DSNP","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/228-4052","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","K21.9","F41.9","E86.0","R62.7","Z66.","R53.83","R63.0","N39.0"],"date":["2021-03-25","2021-03-25","2021-07-13","2021-07-15","2021-07-15","2021-07-15","2021-07-05","2021-07-05","2021-07-05"],"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":[["","68645051554","AMLODIPINE ","5MG","30","Select","Select",""],["","68382080701","TRAZODONE ","150MG","30","Select","Select",""],["","31722099601","HYDROCO\/APAP ","5-325MG","60","Select","Select",""],["","68180047903","SIMVASTATIN ","20MG","90","Select","Select",""],["","08484073200","PRODIGY ","CODING","-50","Select","Select",""],["","68645057054","CITALOPRAM ","20MG","90","Select","Select",""],["","68645014059","FAMOTIDINE ","20MG","30","Select","Select",""],["","31722070290","LOSARTAN ","100MG","90","Select","Select",""],["","68645058259","METFORMIN ","500MG","180","Select","Select",""],["","31722059690","FENOFIBRATE ","145MG","90","Select","Select",""],["","00574200802","NYSTOP ","100000","60","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","10","Select","Select",""],["","031722072250","LEVOFLOXACIN ","500MG","7","Select","Select",""],["","013107008405","LORAZEPAM ","1MG","14","Select","Select",""],["","68382080701","","150MG","-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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}