{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACKIE   L LILLY","gend":0,"add":"243 TRUMP LN","city":"SHAWSVILLE","state":"VA","zip":"24162-9998","dob":"1961-01-16","age":"","mstatus":"","insh":"900045508*01","cliId":"1DH7WE4ET69","pno":"540\/357-1952","cno":"540\/357-1952","email":"","ename":"","eno":"","pphy":"HEMPHILL, JULIA MD","ppno":"540\/268-1400","pcpadd":"6920 ROANOKE RD","pcpcity":"SHAWSVILLE","pcpstate":"VA","pcpzip":24162,"pcpcounty":"","pcpid":147705,"pcpname":"Carilion Family Medicine Shawsville","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/268-1300","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M47.812","F43.0","M47.22","M50.31","M62.838","M50.11","M50.13","E11.9","I10.","Z12.5","G47.33","Z79.899","E78.5","F41.8","L82.1","Z99.89","R05.","R09.89","Z20.822","Z01.812","U07.1","R10.0","R93.3","R11.2","K52.9","N17.9","R79.89","E11.65","G89.29","F32.9","Z79.84","R94.31","R07.9","M54.2","R22.1","Q89.2","J12.82","J96.01","A08.39","Z87.820","M54.12","M50.322","M43.02","M79.601","M50.321","L98.9","M54.07","R59.0"],"date":["2021-01-19","2021-11-08","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-04-20","2021-10-15","2021-10-15","2021-06-04","2021-06-04","2021-10-05","2021-07-22","2021-06-04","2021-06-04","2021-06-04","2021-07-20","2021-07-17","2021-07-30","2021-07-17","2021-07-27","2021-07-21","2021-07-21","2021-07-22","2021-07-27","2021-07-21","2021-07-21","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-20","2021-07-20","2021-10-07","2021-10-06","2021-10-07","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-11-08","2021-09-20","2021-11-08","2021-11-08","2021-11-08","2021-10-15","2021-09-07","2021-10-06"],"priorHcc":["",null,null,null,null,null,"",null,null,"","",null,null,"","","","","",null,"","","","",null,"","","",null,null,null,null,"","",null,null,null,null,null,null,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":[["","43547043109","FENOFIBRATE ","145MG","90","Select","Select",""],["","70377003012","ATORVASTATIN ","80MG","90","Select","Select",""],["","42858080101","MORPHINE ","15MG ER","84","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","65862019430","FLUOXETINE ","40MG","90","Select","Select",""],["","68180052001","LISINOP\/HCTZ ","20-25MG","-90","Select","Select",""],["","65862000899","METFORMIN ","500MG","90","Select","Select",""],["","068462015713","ONDANSETRON ","4MG ODT","-10","Select","Select",""],["","030142035934","","","237","Select","Select",""],["","042806054701","VITAMIN ","1.25MG","5","Select","Select",""],["","000054418625","DEXAMETHASON ","6MG","8","Select","Select",""],["","042806071401","BENZONATATE ","100MG","30","Select","Select",""],["","000093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","051991001406","MELATONIN ","3MG","60","Select","Select",""],["","000731040106","ZINC-220 ","","60","Select","Select",""],["","000904552987","HEARTBURN ","RELIEF","60","Select","Select",""],["","000093274892","FAMOTIDINE ","10MG","60","Select","Select",""],["","43547043109","FENOFIBRATE","145MG","-90","Select","Select",""],["","70377003012","ATORVASTATIN","80MG","90","Select","Select",""],["","42858080101","MORPHINE","15MG ER","84","Select","Select",""],["","65862019430","FLUOXETINE","40MG","90","Select","Select",""],["","68180052001","LISINOP\/HCTZ","20-25MG","-90","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","65862000899","METFORMIN","500MG","90","Select","Select",""],["","42806071401","BENZONATATE","100MG","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00731040106","ZINC-220","","60","Select","Select",""],["","00904552987","HEARTBURN","RELIEF","60","Select","Select",""],["","00093274892","FAMOTIDINE","10MG","60","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","10","Select","Select",""],["","51991001406","MELATONIN","3MG","60","Select","Select",""],["","42806054701","VITAMIN","1.25MG","5","Select","Select",""],["","00054418625","DEXAMETHASON","6MG","8","Select","Select",""],["","65702072910","ACCU-CHEK","GUIDE","1","Select","Select",""],["","65702028810","FASTCLIX","LANCETS","102","Select","Select",""],["","69097094312","GABAPENTIN","300MG","90","Select","Select",""],["","70010075401","METHOCARBAM","500MG","120","Select","Select",""],["","68382005001","MELOXICAM","7.5MG","60","Select","Select",""],["","65702072910","ACCU-CHEK ","KIT GUIDE","1","Select","Select",""],["","68382005001","MELOXICAM ","TAB 7.5MG","60","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","120","Select","Select",""],["","65702028810","FASTCLIX ","MIS LANCETS","102","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}