{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"J   ARDNASSSERDLIHC ","gend":1,"add":"               ENAL CITLAB 571                              ","city":"WYTHEVILLE                    ","state":"VA","zip":"24382-5997","dob":"1968-11-12","age":"","mstatus":"","insh":"50019044","cliId":"","pno":"1667255527","cno":"","email":"","ename":"","eno":"","pphy":"TOMIAK, WILLIAM                                             ","ppno":2762288686,"pcpadd":"1375 W Ridge Rd,","pcpcity":"Wytheville                    ","pcpstate":"VA","pcpzip":243825011,"pcpcounty":"","pcpid":"","pcpname":"CARILION CLINIC FAMILY MEDICIN","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"175 BALTIC LANE","madd2":"                                                            ","madd3":"","mcity":"WYTHEVILLE                    ","mstate":"VA","mzip":"24382-5997","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S42.201D","E78.5","K21.9","M05.79","M79.7","M15.0","M19.031","Z79.899","F41.9","M79.10","Z51.81","M15.9","N76.0","Z01.419","Z11.3","Z11.4","Z12.31","K64.4","Z23","J06.9","R10.819","R30.0","M05.732","M25.832","M06.9","M05.9","M19.90","M89.49","D64.9","R62.7","L08.82","D53.9","M35.9","M85.841","M85.842","G25.89","M19.011","E53.8","M35.00","H04.541","R31.9"],"date":["2021-07-01","2021-07-06","2021-02-11","2021-04-21","2021-04-21","2020-02-19","2019-07-12","2021-07-06","2021-11-24","2019-02-06","2021-04-21","2019-04-19","2019-06-04","2019-06-04","2019-11-19","2019-06-04","2019-07-03","2019-10-17","2020-09-02","2019-10-17","2019-11-19","2021-02-11","2020-02-19","2020-02-19","2021-07-06","2020-11-16","2020-07-15","2021-02-11","2021-07-06","2021-12-17","2021-02-11","2021-03-23","2021-04-21","2021-04-21","2021-04-21","2021-07-01","2021-07-01","2021-07-06","2021-07-06","2021-08-18","2021-11-24"],"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":[["","00574402435","ERYTHROMYCIN","OIN 5MG\/GM","3.5","Select","Select",""],["","00378100501","AZATHIOPRINE","TAB 50MG","90","Select","Select",""],["","00023916360","RESTASIS","EMU 0.0005","60","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","60758088005","FLUOROMETHOL","SUS 0.1% OP","5","Select","Select",""],["","13668044201","CELECOXIB","CAP 200MG","60","Select","Select",""],["","69238154401","HYDROXYCHLOR","TAB 200MG","30","Select","Select",""],["","70700015010","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","00378054101","CIMETIDINE","TAB 800MG","30","Select","Select",""],["","00093720198","PRAVASTATIN","TAB 20MG","30","Select","Select",""],["","00185067401","HYDROXYZ","CAP 25MG","120","Select","Select",""],["","72205001790","PREGABALIN","CAP 225MG","60","Select","Select",""],["","71921017309","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","15","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","70700026894","FOSFOMYCIN","POW 3GM","1","Select","Select",""],["","51293061101","PHENAZOPYRID","TAB 100MG","6","Select","Select",""],["","51672131200","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","64380080308","RANITIDINE","TAB 150MG","60","Select","Select",""],["","00069050130","XELJANZ","TAB 11MG","30","Select","Select",""],["","62332000191","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","59746017210","PREDNISONE","TAB 5MG","90","Select","Select",""],["","59212056210","PLAQUENIL","TAB 200MG","90","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","14","Select","Select",""],["","00071101968","LYRICA","CAP 225MG","60","Select","Select",""],["","00003218811","ORENCIA","INJ 125MG\/ML","4","Select","Select",""],["","16729016917","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00781506120","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","57664050289","TIZANIDINE","TAB 2MG","20","Select","Select",""],["","00168008031","HYDROCORT","CRE 0.025","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":""}]}]}