{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOYCE   A GARRISON","gend":1,"add":"101 COUNTRY ESTATES BLVD","city":"CRIMORA","state":"VA","zip":"24431-9998","dob":"1954-03-03","age":"","mstatus":"","insh":"900044219*01","cliId":"1VC2H41PX08","pno":"540\/487-0219","cno":"540\/487-0219","email":"","ename":"","eno":"","pphy":"DUNBAR, KATHLEEN S MD","ppno":"540\/949-8241","pcpadd":"428 S MAGNOLIA AVE","pcpcity":"WAYNESBORO","pcpstate":"VA","pcpzip":22980,"pcpcounty":"","pcpid":147705,"pcpname":"Carilion Family Medicine Associated Physicians","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/949-5582","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.31","M54.16","Z98.890","M79.604","M51.16","M47.26","M48.061","Z98.1","M43.16","M47.816"],"date":["2021-03-09","2021-10-18","2021-10-18","2021-11-04","2021-10-18","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-09-28"],"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":[["","000069046956","CHANTIX ","1MG","60","Select","Select",""],["","000116200116","CHLORHEX ","0.12%","-473","Select","Select",""],["","031722094101","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","000781261305","AMOXICILLIN ","500MG","32","Select","Select",""],["","000054485925","TRIAZOLAM ","0.25MG","2","Select","Select",""],["","068645056259","IBUPROFEN ","600MG","20","Select","Select",""],["","055111064530","OMEPRAZOLE ","40MG","90","Select","Select",""],["","068462025601","ROPINIROLE ","2MG","90","Select","Select",""],["","062332015130","OLM ","40-25MG","-90","Select","Select",""],["","055111017915","TIZANIDINE ","2MG","90","Select","Select",""],["","057237001999","DULOXETINE ","60MG","90","Select","Select",""],["","068645019059","METOPROL ","50MG","60","Select","Select",""],["","059746017509","PREDNISONE ","20MG","20","Select","Select",""],["","050228018005","GABAPENTIN ","300MG","450","Select","Select",""],["","000054418125","DEXAMETHASON ","1MG","15","Select","Select",""],["","00781261305","","500MG","32","Select","Select",""],["","00054418125","DEXAMETHASON","1MG","15","Select","Select",""],["","00054485925","TRIAZOLAM","0.25MG","2","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","32","Select","Select",""],["","68645056259","IBUPROFEN","600MG","20","Select","Select",""],["","00069046956","CHANTIX","1MG","60","Select","Select",""],["","55111064530","OMEPRAZOLE","40MG","90","Select","Select",""],["","57237001930","DULOXETINE","60MG","90","Select","Select",""],["","50228018005","GABAPENTIN","300MG","450","Select","Select",""],["","43547027150","ROPINIROLE","2MG","90","Select","Select",""],["","62332015130","OLM","40-25MG","-90","Select","Select",""],["","55111017915","TIZANIDINE","2MG","90","Select","Select",""],["","59746017509","PREDNISONE","20MG","20","Select","Select",""],["","00378003210","METOPROL","50MG","180","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","60","Select","Select",""],["","10702000709","CYCLOBENZAPR ","TAB 10MG","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","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}