{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CURTIS S JEWELL","gend":0,"add":"6910 WILLIAMSON ROAD ROANOKE ASSISTED LIVING","city":"ROANOKE","state":"VA","zip":"24019-9998","dob":"1987-06-07","age":"","mstatus":"","insh":"20063300*01","cliId":"","pno":5402652173,"cno":5402652173,"email":"","ename":"","eno":"","pphy":"CARLTON, RYAN A NP","ppno":8007657130,"pcpadd":"6701 PETERS CREEK RD STE 110,","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":"24019-9998","pcpcounty":"","pcpid":"","pcpname":"Premier Geriatric Solutions","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":2012289980,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","E87.1","E03.9","E78.2","E55.9","I10.","K21.9","F25.9","F17.210","Z91.81","F31.9","F20.9","Z59.9","Z65.8","M79.662","E78.5","F12.90","F17.200","G21.19","R94.31","R41.82","R00.1","R26.89","R25.1","G93.40","R26.2","F81.9","R29.6","G40.909","H40.003","E22.2","Z20.822","R63.1","F45.8","F54.","F20.1","Z79.890","Z79.899"],"date":["2023-07-18","2022-02-25","2023-01-28","2021-09-21","2021-09-21","2023-08-10","2022-06-16","2021-09-21","2022-01-14","2021-09-21","2022-01-17","2023-07-18","2023-02-08","2023-02-08","2022-01-12","2023-01-28","2023-01-31","2023-01-31","2023-08-10","2023-01-28","2023-01-28","2023-01-31","2022-03-02","2022-03-02","2023-02-02","2023-08-10","2023-02-02","2023-02-02","2023-08-10","2022-04-29","2022-01-14","2023-01-28","2022-01-19","2022-01-14","2022-01-19","2023-01-29","2022-02-25","2022-02-25"],"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":[]},{"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":[["","50383077916","LACTULOSE","10 G\/15 ML","1892","Select","Select",""],["","60505327503","OLANZAPINE","TAB 5MG ODT","28","Select","Select",""],["","62756079713","DIVALPROEX","TAB 250MG DR","56","Select","Select",""],["","00781507701","LORATADINE","TAB 10MG","28","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","67457035959","FLUPHENAZ DE","INJ 25MG\/ML","5","Select","Select",""],["","49281042050","FLUZONE QUAD","INJ 2020-21","0","Select","Select",""],["","00603243921","BENZTROPINE","TAB 2MG","56","Select","Select",""],["","00093075301","ATENOLOL","TAB 100MG","28","Select","Select",""],["","61442012110","FAMOTIDINE","20 MG","56","Select","Select",""],["","00378180977","LEVOTHYROXIN","TAB 100MCG","28","Select","Select",""],["","65162071310","GUANFACINE","TAB 2MG","28","Select","Select",""],["","16729000515","SIMVASTATIN","TAB 20MG","56","Select","Select",""],["","00904198280","MAPAP","TAB 325MG","60","Select","Select",""],["","54629041120","VITAMIN D3","TAB 2000UNIT","28","Select","Select",""],["","68462026290","ROSUVASTATIN","TAB 10MG","28","Select","Select",""],["","70461032103","FLUCLVX QUAD","INJ 2021-22","0","Select","Select",""],["","16571016010","TRIHEXYPHEN","TAB 2MG","30","Select","Select",""],["","65162071310","GUANFACINE HCL","2 MG","28","Select","Select",""],["","00378180977","LEVOTHYROXINE SODIUM","100 MCG","28","Select","Select",""],["","60505327803","OLANZAPINE ODT","20 MG","56","Select","Select",""],["","68462026290","ROSUVASTATIN CALCIUM","10 MG","28","Select","Select",""],["","62756079813","DIVALPROEX SODIUM","500 MG","56","Select","Select",""],["","00591533501","TRIHEXYPHENIDYL HCL","2 MG","28","Select","Select",""],["","33332032203","AFLURIA QUAD","2022-23 (3YR UP) 60MCG\/.5ML","0.5","Select","Select",""],["","67457035959","FLUPHENAZINE DECANOATE","25 MG\/ML","5","Select","Select",""],["","70461032103","FLUCLVX QUAD INJ","2021-22","0","Select","Select",""],["","60505327503","OLANZAPINE TAB","5MG ODT","28","Select","Select",""],["","00603243921","BENZTROPINE TAB","2MG","56","Select","Select",""],["","67457035959","FLUPHENAZ DE INJ","25MG\/ML","5","Select","Select",""],["","62756079813","DIVALPROEX TAB","500MG DR","56","Select","Select",""],["","00378180977","LEVOTHYROXIN TAB","100MCG","28","Select","Select",""],["","16729000515","SIMVASTATIN TAB","20MG","56","Select","Select",""],["","61442012110","FAMOTIDINE TAB","20MG","56","Select","Select",""],["","65162071310","GUANFACINE TAB","2MG","28","Select","Select",""],["","50383077916","LACTULOSE SOL","10GM\/15","1892","Select","Select",""],["","68462026290","ROSUVASTATIN TAB","10MG","28","Select","Select",""],["","16571016010","TRIHEXYPHEN TAB","2MG","27","Select","Select",""],["","10370051150","DIVALPROEX SODIUM ER","500 MG","110","Select","Select",""],["","59316010212","BIOFREEZE","4 %","89","Select","Select",""],["","40985022639","GLUCOSAMINE-CHONDROITIN","500-400 MG","36","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":""}]}]}