{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELRAHCNYWG S","gend":0,"add":"OB OP272 X","city":"GALAX","state":"VA","zip":"24333-0272","dob":"1965-05-07","age":"","mstatus":"","insh":"50018889","cliId":"","pno":"3767269833","cno":2767333897,"email":"","ename":"","eno":"","pphy":"BUTLER, AMY","ppno":2762366136,"pcpadd":"199 Hospital Dr Ste 7, ","pcpcity":"Galax","pcpstate":"VA","pcpzip":243332453,"pcpcounty":"","pcpid":"","pcpname":"CARILION CLINIC FAMILY AND INT","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 272","madd2":"","madd3":"","mcity":"GALAX","mstate":"VA","mzip":"24333-0272","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G25.81","G90.09","J30.2","F41.1","M79.2","F41.9","S89.92XA","J96.12","J44.9","G89.29","I10","R60.0","E78.5","K21.9","F32.9","G60.9","J32.9","Z79.891","R10.32","K35.80","G89.18","I50.32","J96.11","I11.0","E87.1","F17.210","K42.9","Z20.822","G47.33","G62.9","Z99.81","Z91.14","Z88.6","R10.11","R10.31","R11.0","R06.02","R10.9","Z72.0","K40.90","K35.30","L03.311","R91.1","I50.9","E66.9","Z79.899","Z90.89","J43.9","I25.10","R91.8","K59.04","L03.119","R05","H66.91","E83.42","Z12.5","E78.2","R81","R73.03","G47.00","J20.9","H10.13"],"date":["2022-01-03","2020-01-07","2022-01-03","2020-01-07","2020-05-04","2022-01-03","2020-03-26","2022-03-15","2022-03-15","2020-05-04","2022-01-03","2022-01-31","2022-01-03","2022-01-03","2022-01-03","2022-01-03","2020-12-01","2022-01-03","2021-04-16","2021-05-13","2021-05-12","2021-05-12","2021-05-12","2021-06-02","2021-05-12","2021-06-02","2021-05-13","2021-05-12","2021-05-13","2021-05-12","2021-05-13","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-06-02","2021-05-13","2021-05-13","2021-05-13","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-07-16","2022-01-31","2019-02-25","2019-03-01","2019-04-19","2019-04-19","2019-04-19","2019-04-19","2019-04-19","2019-04-19","2019-10-10","2019-10-10"],"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":[["","76204020001","ALBUTEROL","76204020001 ALBUTEROL ","270","Select","Select",""],["","17478029111","CROMOLYN","SOL 4% OP","10","Select","Select",""],["","00228203110","ALPRAZOLAM","00228203110 ALPRAZOLAM ","120","Select","Select",""],["","33342010215","MONTELUKAST","33342010215 MONTELUKAST ","30","Select","Select",""],["","31722070290","LOSARTAN","31722070290 LOSARTAN ","30","Select","Select",""],["","00093720198","PRAVASTATIN","00093720198 PRAVASTATIN ","30","Select","Select",""],["","00591288401","VERAPAMIL","00591288401 VERAPAMIL ","30","Select","Select",""],["","60951071270","ENDOCET","60951071270 ENDOCET ","120","Select","Select",""],["","16714089802","LORATADINE","16714089802 LORATADINE ","30","Select","Select",""],["","00186037020","SYMBICORT","00186037020 SYMBICORT ","10.2","Select","Select",""],["","16714066102","GABAPENTIN","16714066102 GABAPENTIN ","90","Select","Select",""],["","00603020922","MAG","TAB 400MG","30","Select","Select",""],["","59310057922","PROAIR","59310057922 PROAIR ","8.5","Select","Select",""],["","43547040110","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","68462033190","PRAMIPEXOLE","TAB 0.25MG","30","Select","Select",""],["","13668001001","CITALOPRAM","13668001001 CITALOPRAM ","30","Select","Select",""],["","60432026415","FLUTICASONE","60432026415 FLUTICASONE ","16","Select","Select",""],["","16714049401","AMOX\/K","16714049401 AMOX\/K ","14","Select","Select",""],["","68180012202","CEPHALEXIN","68180012202 CEPHALEXIN ","21","Select","Select",""],["","00406052301","OXYCOD\/APAP","00406052301 OXYCOD\/APAP ","120","Select","Select",""],["","50111078751","AZITHROMYCIN","50111078751 AZITHROMYCIN ","6","Select","Select",""],["","59651000205","OMEPRAZOLE","59651000205 OMEPRAZOLE ","30","Select","Select",""],["","45802086803","POLYETH","45802086803 POLYETH ","510","Select","Select",""],["","51660072415","ALLERGY","TAB DECONGES","30","Select","Select",""],["","49281063315","FLUZONE","INJ 2020-21","0.5","Select","Select",""],["","65162027250","SMZ\/TMP","65162027250 SMZ\/TMP ","20","Select","Select",""],["","29033000301","SUCRALFATE","29033000301 SUCRALFATE ","42","Select","Select",""],["","00456120330","LINZESS","CAP 72MCG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","16714062101","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","16714029904","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","33332031901","AFLURIA","INJ 2019-20","0.5","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":""}]}]}