{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIMOTHY   W ROCK","gend":0,"add":"6910 WILLIAMSON ROAD NORTH ROANOKE ALF","city":"ROANOKE","state":"VA","zip":"24019-9998","dob":"1958-01-22","age":"","mstatus":"","insh":"20063583*01","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"PALMERTON, TODD MD","ppno":"540\/265-5500","pcpadd":"6415 PETERS CREEK RD","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24019,"pcpcounty":"","pcpid":"","pcpname":"Carilion Family Medicine North Roanoke","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/265-5515","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.9","T42.0X1A","J18.9","R89.2","R07.89","R11.2","R29.6","R09.02","H55.09","R26.89","Z72.0","R41.0","F20.3","B35.1","L60.2","M79.674","M79.675","B35.6","G40.909","F17.200","L03.031","L72.3","L03.032","E55.9","E53.8","R91.8","M79.671","M79.672","H25.13","N17.9","F05.","T42.0X5A","Z20.822","D64.9","F17.210","V58.89","Z86.69","R78.89","Z60.9","Z59.9"],"date":["2021-12-02","2021-03-24","2021-03-31","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-20","2021-03-20","2021-03-20","2021-03-20","2021-03-20","2021-03-20","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2020-08-05","2021-09-01","2021-03-24","2020-12-10","2021-11-04","2021-04-15","2021-09-01","2021-09-01","2021-09-01","2021-06-17","2021-06-17","2021-10-21","2021-03-20","2021-03-19","2021-03-19","2021-03-19","2021-03-19","2021-03-19","2021-03-31","2021-03-24","2021-03-17","2021-12-02","2021-12-02"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0","Select","Select",""],["","","CLOZAPINE","TAB 200MG","","Select","Select",""],["","","PHENYTOIN","CAP 100MG","","Select","Select",""],["","","DOCUSATE","CAP 100MG","","Select","Select",""],["","","PAROXETINE","TAB 40MG","","Select","Select",""],["","","MELATONIN","TAB 10MG CR","","Select","Select",""],["","","TOPIRAMATE","TAB 200MG","","Select","Select",""],["","","VITAMIN","TAB 1000MCG","","Select","Select",""],["","","CLOTRIMAZOLE","CRE 0.01","","Select","Select",""],["","","ALENDRONATE","TAB 70MG","","Select","Select",""],["","","PREVNAR","INJ ","","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0","Select","Select",""],["","00536589671","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","","PAIN","TAB 500MG","","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}