{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THOMAS   N EDMONDSON","gend":0,"add":"60 BRYANT RD APT 5","city":"ROANOKE","state":"VA","zip":"24019-9998","dob":"1955-10-20","age":"","mstatus":"","insh":"900046815*01","cliId":"9G30CP0PJ10","pno":"540\/353-7608","cno":"540\/353-7608","email":"","ename":"","eno":"","pphy":"CARPIO, LAWRENCE DO","ppno":"540\/265-5500","pcpadd":"6415 PETERS CREEK RD","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24019,"pcpcounty":"","pcpid":147705,"pcpname":"Carilion Family Medicine North Roanoke","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/265-5515","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I25.10","I10.","E78.5","R06.02","I25.82"],"date":["2021-10-26","2021-04-20","2021-04-20","2021-04-20","2021-04-20"],"priorHcc":[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":[["","68180052001","LISINOP\/HCTZ","TAB 20-25MG","90","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","75","Select","Select",""],["","68382065005","ISOSORB MONO","TAB 30MG ER","180","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","180","Select","Select",""],["","55111072901","ALLOPURINOL","TAB 100MG","90","Select","Select",""],["","68382075810","METFORMIN HYDROCHLORIDE","","180","Select","Select",""],["","43598043611","NITROGLYCERIN ","","25","Select","Select",""],["","68180052001","LISINOPRIL\/HYDROCHLOROTHIAZIDE","","90","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM ","","90","Select","Select",""],["","68382065005","ISOSORBIDE MONONITRATE ER ","","180","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM","","90","Select","Select",""],["","43598043611","NITROGLYCERIN","","25","Select","Select",""],["","68382065005","ISOSORBIDE MONONITRATE ER","","180","Select","Select",""],["","57664016758","METOPROLOL TARTRATE","","180","Select","Select",""],["","43598043611","NITROGLYCERIN                                                         ","SUB 0.4MG","25","Select","Select",""],["","68382075810","METFORMIN HYDROCHLORIDE                                               ","TAB 500MG","180","Select","Select",""],["","68382065005","ISOSORBIDE MONONITRATE ER                                             ","TAB 30MG ER","180","Select","Select",""],["","55111072901","ALLOPURINOL                                                           ","TAB 100MG","90","Select","Select",""],["","68180052001","LISINOPRIL\/HYDROCHLOROTHIAZIDE                                        ","TAB 20-25MG","90","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM                                                  ","TAB 40MG","90","Select","Select",""],["","57664016758","METOPROLOL TARTRATE                                                   ","TAB 100MG","180","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":""}]}]}