{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAMA ALBALKHI","gend":1,"add":"60 OTTER AVE APT 80","city":"SALEM","state":"VA","zip":"24153-9998","dob":"1984-01-26","age":"","mstatus":"","insh":"1912888*01","cliId":"","pno":"540\/676-0869","cno":"540\/676-0869","email":"","ename":"","eno":"","pphy":"GREENAWALD, MARK MD","ppno":"540\/562-5700","pcpadd":"1314 PETERS DREEK RD","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24017,"pcpcounty":"","pcpid":137700,"pcpname":"Inpatient Carilion Roanoke Memorial Hospital","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.00","G56.01","M77.01","G56.20","Z01.419","Z30.41","E66.3","J30.9","L30.9","E89.0","F41.9","R06.02","J39.8","R10.11","M25.551","K21.9","R10.13","G56.21","M54.41","L70.0","J01.10","E53.8","E55.9","L65.9","R10.9","R40.0"],"date":["2021-11-08","2020-06-16","2020-06-16","2020-02-20","2021-03-03","2021-03-03","2020-07-13","2021-11-08","2020-07-13","2021-11-08","2021-11-08","2021-11-15","2020-01-09","2020-09-15","2020-09-15","2021-11-08","2020-10-01","2020-06-16","2021-11-08","2021-11-08","2021-08-05","2021-08-05","2021-08-05","2021-11-08","2021-11-08","2021-11-15"],"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":[["","69238183807","LEVOTHYROXIN ","150MCG","30","Select","Select",""],["","13668013610","ESCITALOPRAM ","10MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","66993058497","FLUTIC\/SALME ","100\/50","60","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","26","Select","Select",""],["","70700011585","SYEDA ","3-0.03MG","28","Select","Select",""],["","51672129201","HC ","0.20%","15","Select","Select",""],["","00781165510","PENICILLN ","500MG","29","Select","Select",""],["","00168008031","HYDROCORT ","2.50%","30","Select","Select",""],["","48878313004","CLINPRO ","1.10%","113","Select","Select",""],["","62175061746","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","20","Select","Select",""],["","65862086001","FAMOTIDINE ","40MG","30","Select","Select",""],["","00713063337","METRONIDAZOL ","0.75%","45","Select","Select",""],["","54629058501","VITAMIN ","500MCG","30","Select","Select",""],["","00173069500","ADVAIR ","100\/50","60","Select","Select",""],["","62559043130","HYDROCORTISO ","2.50%","30","Select","Select",""],["","55111017915","TIZANIDINE ","2MG","60","Select","Select",""],["","00536106229","STOOL ","100MG","30","Select","Select",""],["","00527293337","PREDNISONE ","10MG","20","Select","Select",""],["","00781185220","AMOX\/K ","875-125","20","Select","Select",""],["","80681005000","DAILY-VITE ","","30","Select","Select",""],["","16571040250","CETIRIZINE ","10MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","13668013610","ESCITALOPRAM","10MG","30","Select","Select",""],["","66993058497","FLUTIC\/SALME","100\/50","60","Select","Select",""],["","00093317431","ALBUTEROL","HFA","26","Select","Select",""],["","51672129201","HC","0.20%","15","Select","Select",""],["","00168014630","HYDROCORT","2.50%","28","Select","Select",""],["","70700011585","SYEDA","3-0.03MG","28","Select","Select",""],["","69238183807","LEVOTHYROXIN","150MCG","30","Select","Select",""],["","00781165510","PENICILLN","500MG","29","Select","Select",""],["","48878313004","CLINPRO","1.10%","113","Select","Select",""],["","67877032105","IBUPROFEN","800MG","20","Select","Select",""],["","62175061746","PANTOPRAZOLE","40MG","30","Select","Select",""],["","62332000231","FAMOTIDINE","40MG","30","Select","Select",""],["","00173069500","ADVAIR","100\/50","60","Select","Select",""],["","00536106229","STOOL","100MG","30","Select","Select",""],["","00713063337","METRONIDAZOL","0.75%","45","Select","Select",""],["","00527293337","PREDNISONE","10MG","20","Select","Select",""],["","62559043130","HYDROCORTISO","2.50%","30","Select","Select",""],["","55111017915","TIZANIDINE","2MG","60","Select","Select",""],["","54629058501","VITAMIN","500MCG","30","Select","Select",""],["","80681005000","DAILY-VITE","","30","Select","Select",""],["","00781185220","AMOX\/K","875-125","20","Select","Select",""],["","16571040250","CETIRIZINE","10MG","30","Select","Select",""],["","00143980250","DOXYCYCL ","CAP 50MG","28","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}