{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"K   NARYBGNINNAM ","gend":0,"add":"NOT O\/CERAB AJ","city":"BOONS MILL","state":"VA","zip":"24065-3969","dob":"1966-09-06","age":"","mstatus":"","insh":"50018386","cliId":"","pno":"6704580529","cno":"","email":"","ename":"","eno":"","pphy":"LLAVORE, JEREMY A","ppno":5403345511,"pcpadd":"22890 Virgil H Goode Hwy, ","pcpcity":"Boones Mill","pcpstate":"VA","pcpzip":240654989,"pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY AND INTERNAL MEDICINE BOONES MILL","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"7980 GRASSY HILL RD","add3":"","madd1":"5060 Valley View Blvd Nw","madd2":"","madd3":"","mcity":"Roanoke","mstate":"VA","mzip":"24012-2038","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.239","F33.2","F05","R55","R45.851","F32.9","I10","R56.9","F10.10","F10.20","Y90.8","E44.1","G81.91","I13.0","I50.32","F10.229","F17.200","G40.909","I69.30","N18.3","Z91.5","Z88.9","Z88.1","F10.129","K21.9","N18.2","F17.210","N17.9","I69.351","N18.9","F10.24","F41.9","G62.9","Z59.0","Z63.8","Z91.14","F41.8","Z72.0","S40.811A","I77.810","I70.0","R11.2","R68.89","Z79.899","J96.91","J18.9","Z86.59","F60.9","G47.00","R11.0","R51","S00.03XA","J98.4","W01.10XA","I50.9","R40.2362","R40.2142","R40.2252","W19.XXXA","I11.0","Z86.73","T14.91XA","R90.89","R47.01","S09.8XXA","G31.9","M54.9","M54.5","S39.012A","M51.36","M51.37","Z86.14","Z87.820","Z86.19","Z79.82","M54.89","D72.829","F19.94","R74.0","D72.825","V89.2XXA","Y92.410","E78.5","G89.29","S00.81XA","N28.9","R79.89","R94.5","F41.1","F31.9","F10.14","F41.0","Z56.0","F43.10","R00.0","Z91.19","F48.9","T20.36XA","T30.0","X76.XXXA","Y93.89","Y92.481","T20.311A","T20.312A","T21.31XA","T21.32XA","T22.332A","T22.311A","T23.301A","T24.312A","T24.301A","T25.312A","T27.3XXA","T20.39XA","T21.39XA","T22.391A","T22.392A","T24.391A","T24.392A","J96.00","T31.52","T24.331A","T24.311A","T22.322A","T24.332A","T31.55","R91.8","T20.30XA","T23.302A","T20.35XA","T20.07XA","X75.XXXA","T31.44","T23.392A","T23.391A","G93.49","Z66","T79.A12A","T23.201A","R41.82","T31.40","Z46.82","I46.9","F33.9","F60.3","F10.120","Y90.6","F10.920","B19.10","R69","R73.03","R31.9","Z88.6","R46.2","I50.30","T51.0X1A","B02.9","E87.6","E83.51","Z88.5","R10.13","R10.9","M25.572","S82.62XA","R73.9","F19.120","S82.65XA","W18.42XA","S93.402A","E86.0","Z71.6","S82.425A","F10.230","X58.XXXA","Y92.9","D50.9","I12.9","I69.359","R44.1","Z04.89","G54.0","M25.579","Z88.8","D63.1","K29.70","F10.929","F33.1","F10.21","F10.220","V89.2XXS","Z81.1","Z81.8","F11.20","T42.4X2A","G93.40","D64.9","T42.4X1A","L02.811","A41.9","B18.1","J36","L02.01","E83.39","E83.42","M19.011","S69.81XA","S99.811A","E87.8","R22.0","R59.1","L98.9","S50.811A","F19.10","Z87.891","Z91.81","S09.90XA","Z04.3","F32.89","R40.2412","M47.812","M50.31","S06.9X9A","S19.9XXA","Y90.1","F19.14","F60.7","F99","F33.3","G56.91","M21.331","R25.1","K86.1","E88.09","R25.9","R53.1","T43.595A","F19.939","R44.3","B02.29","K75.9","R19.7","K59.00","F31.4","E87.0","R50.9","E87.2","E87.1","F13.20","Z76.5","G40.89","Z53.21","X78.0XXA","M48.56XA","Z53.20","J44.9","I77.1","S32.030A","F10.99","J02.9","E78.1","S32.040D","J44.1","Y90.7","S01.112A","S01.121A","Z09","K73.9","R40.2360","R40.2250","E51.2","S00.91XA","W22.8XXA","F19.24","Z79.891","Z79.810","Z79.52","R40.4","F29","R41.0","R09.89"],"date":["2020-03-02","2020-03-02","2020-01-02","2020-01-03","2020-03-06","2020-02-24","2020-03-06","2020-02-28","2020-03-07","2020-02-28","2020-02-10","2020-01-07","2020-02-26","2020-01-07","2020-02-02","2020-02-26","2020-02-10","2020-02-26","2020-01-07","2020-02-02","2020-02-10","2020-01-20","2020-01-07","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-02-27","2020-01-20","2020-01-20","2020-02-26","2020-03-06","2020-01-20","2020-03-07","2020-02-10","2020-01-20","2020-01-22","2020-02-13","2020-01-23","2020-01-25","2020-01-25","2020-01-25","2020-02-23","2020-01-26","2020-01-26","2020-01-26","2020-01-27","2020-02-02","2020-02-10","2020-02-06","2020-02-06","2020-02-06","2020-02-06","2020-02-06","2020-02-28","2020-02-06","2020-02-06","2020-02-06","2020-02-10","2020-02-26","2020-02-24","2020-03-07","2020-02-14","2020-02-14","2020-02-20","2020-02-20","2020-02-28","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-03-06","2020-02-24","2020-02-23","2020-03-06","2020-02-24","2020-02-24","2020-02-24","2020-02-26","2020-02-24","2020-02-26","2020-02-26","2020-02-26","2020-03-06","2020-02-26","2020-02-26","2020-02-27","2020-02-28","2020-03-01","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-07","2020-03-07","2020-03-07","2020-03-07","2020-03-08","2020-03-07","2020-03-08","2020-03-07","2020-03-07","2020-03-08","2020-03-08","2020-03-07","2020-03-07","2020-03-07","2020-03-07","2020-03-07","2020-03-07","2020-03-07","2020-03-08","2020-03-07","2020-03-07","2020-03-07","2020-03-08","2020-03-08","2020-03-07","2020-03-07","2020-03-08","2020-03-07","2020-03-07","2020-03-07","2020-03-07","2020-03-08","2020-03-09","2020-03-09","2020-03-08","2020-03-08","2020-03-08","2020-03-08","2020-03-08","2020-03-08","2020-03-08","2020-03-10","2020-03-09","2020-03-09","2020-03-09","2020-03-10","2020-03-09","2020-03-10","2019-10-09","2019-08-22","2019-01-14","2019-01-14","2019-01-14","2019-11-15","2019-03-26","2019-06-02","2019-03-27","2019-10-28","2019-08-22","2019-12-29","2019-04-12","2019-10-14","2019-11-09","2019-04-12","2019-04-12","2019-04-12","2019-04-12","2019-05-25","2019-05-22","2019-05-22","2019-05-22","2019-06-03","2019-05-25","2019-05-25","2019-12-29","2019-05-25","2019-05-25","2019-10-25","2019-12-02","2019-12-02","2019-11-13","2019-10-03","2019-10-25","2019-05-28","2019-10-17","2019-10-22","2019-05-30","2019-11-22","2019-06-02","2019-10-14","2019-12-30","2019-09-03","2019-06-05","2019-11-05","2019-06-14","2019-06-14","2019-06-24","2019-06-23","2019-06-23","2019-12-30","2019-10-14","2019-06-23","2019-06-24","2019-07-01","2019-10-22","2019-07-01","2019-06-30","2019-06-30","2019-11-08","2019-06-30","2019-06-30","2019-06-30","2019-07-02","2019-07-02","2019-07-02","2019-07-02","2019-07-04","2019-09-06","2019-07-20","2019-08-11","2019-07-20","2019-08-11","2019-08-05","2019-08-05","2019-08-05","2019-08-05","2019-08-05","2019-08-05","2019-08-17","2019-08-22","2019-08-22","2019-08-22","2019-10-17","2019-08-29","2019-08-29","2019-09-06","2019-09-06","2019-09-09","2019-09-19","2019-09-19","2019-09-23","2019-10-03","2019-10-03","2019-12-19","2019-10-14","2019-12-31","2019-10-22","2019-10-25","2019-11-06","2019-10-28","2019-10-28","2019-10-29","2019-10-31","2019-11-01","2019-11-01","2019-11-01","2019-11-06","2019-11-22","2019-11-06","2019-12-29","2019-11-06","2019-11-12","2019-11-13","2019-11-13","2019-11-19","2019-11-15","2019-11-22","2019-12-02","2019-12-02","2019-12-02","2019-12-02","2019-12-04","2019-12-04","2019-12-04","2019-12-12","2019-12-11","2019-12-11","2019-12-19","2019-12-19","2019-12-19","2019-12-19","2019-12-23","2019-12-23","2019-12-23","2019-12-30"],"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":[["","00172572860","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","57237004805","DIVALPROEX","TAB 500MG DR","90","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","45","Select","Select",""],["","65162010350","GABAPENTIN","CAP 400MG","90","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","10","Select","Select",""],["","00363056314","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","00536641208","MELATONIN","TAB 3MG","60","Select","Select",""],["","69238117009","DOXEPIN","CAP 25MG","45","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","10","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","10","Select","Select",""],["","59651000205","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","68382079101","ACYCLOVIR","TAB 400MG","30","Select","Select",""],["","69315012701","FOLIC","TAB 1000MCG","30","Select","Select",""],["","00555015902","CHLORDIAZEP","CAP 25MG","30","Select","Select",""],["","11917009502","THERAGRAN-M","TAB 50 PLUS","30","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","00501373005","NEOSPORIN","OIN ORIGINAL","15","Select","Select",""],["","00186038230","ESOMEPRA","CAP 20MG DR","30","Select","Select",""],["","00115180401","HYDROXYZ","CAP 50MG","60","Select","Select",""],["","00406117003","NALTREXONE","TAB 50MG","15","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00904671546","RANITIDINE","TAB 75MG","60","Select","Select",""],["","31604001281","VITAMIN","TAB 100MG","30","Select","Select",""],["","00115175701","CYPROHEPTAD","TAB 4MG","30","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":""}]}]}