{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KERRI   J WILLIAMS","gend":1,"add":"3701 PEPPERS FERRY RD","city":"RADFORD","state":"VA","zip":"24141-9998","dob":"1990-11-06","age":"","mstatus":"","insh":"900042734*01","cliId":"1G35R87HT66","pno":"540\/250-8275","cno":"540\/250-8275","email":"","ename":"","eno":"","pphy":"JORDAN, CHRISTINE MD","ppno":"540\/951-6070","pcpadd":"3698 SOUTH MAIN ST","pcpcity":"BLACKSBURG","pcpstate":"VA","pcpzip":24060,"pcpcounty":"","pcpid":136562,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/951-6071","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G89.4","M54.16","Z79.899","E66.9","F33.41","F41.1","M54.5","M51.36","F31.81","E87.6","R07.9","D31.32","H25.13"],"date":["2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-04-19","2021-02-03","2021-02-03","2021-02-22","2021-11-16","2021-10-25","2021-11-04","2021-11-04"],"priorHcc":[null,null,null,null,null,"","","","",null,null,null,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":[["","29300011416","LAMOTRIGINE","TAB 200MG","30","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","120","Select","Select",""],["","832167211","FLUVOXAMINE","TAB 100MG","60","Select","Select",""],["","781107710","ALPRAZOLAM","TAB 0.5MG","90","Select","Select",""],["","69547035302","NARCAN","SPR ","4","Select","Select",""],["","406012305","HYDROCO\/APAP","TAB 5-325MG","90","Select","Select",""],["","33342006807","OLANZAPINE","TAB 5MG","30","Select","Select",""],["","69238183901","LEVOTHYROXIN","TAB 175MCG","90","Select","Select",""],["","70700011985","ESTARYLLA","TAB 0.25-35","84","Select","Select",""],["","832167211","FLUVOXAMINE MALEATE","","60","Select","Select",""],["","70700011985","ESTARYLLA ","","84","Select","Select",""],["","406012305","HYDROCODONE\/ACETAMINOPHEN ","","90","Select","Select",""],["","69238183901","LEVOTHYROXINE SODIUM ","","90","Select","Select",""],["","69238183901","LEVOTHYROXINE SODIUM","","90","Select","Select",""],["","00406012305","HYDROCODONE\/ACETAMINOPHEN","","90","Select","Select",""],["","00406012305","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","5-325MG","90","Select","Select",""],["","33342006707","OLANZAPINE                                                            ","TAB 2.5MG","60","Select","Select",""],["","65162062711","TRAMADOL HCL                                                          ","TAB 50MG","120","Select","Select",""],["","29300011416","LAMOTRIGINE                                                           ","TAB 200MG","30","Select","Select",""],["","69238183901","LEVOTHYROXINE SODIUM                                                  ","TAB 175MCG","90","Select","Select",""],["","00228202996","ALPRAZOLAM                                                            ","TAB 0.5MG","90","Select","Select",""],["","00832167211","FLUVOXAMINE MALEATE                                                   ","TAB 100MG","60","Select","Select",""],["","70700011985","ESTARYLLA                                                             ","TAB 0.25-35","84","Select","Select",""],["","00406012305","HYDROCODONE\/ACETAMINOPHEN                                             ","TAB 5-325MG","90","Select","Select",""],["","69547035302","NARCAN                                                                ","SPR ","-4","Select","Select",""],["","00406012305","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","TAB 5-325MG","90","Select","Select",""],["","67877043203","ARIPIPRAZOLE                                                          ","TAB 10MG","30","Select","Select",""],["","65862077685","MILI                                                                  ","TAB 0.25\/35","84","Select","Select",""],["","68382039801","POTASSIUM CHLORIDE ER                                                 ","TAB 20MEQ ER","30","Select","Select",""],["","68180013501","ESCITALOPRAM OXALATE                                                  ","TAB 10MG","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","",""],["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":""}]}]}