{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A NEVETSPANKLEB ","gend":0,"add":"CIW 6531ENAL REK","city":"VINTON","state":"VA","zip":24179,"dob":"1985-01-09","age":"","mstatus":"","insh":"60013167","cliId":"","pno":"9204555523","cno":5406329041,"email":"","ename":"","eno":"","pphy":"THOMPSON, JAMES","ppno":5402932555,"pcpadd":"548 BLUE RIDGE AVE,","pcpcity":"BEDFORD","pcpstate":"VA","pcpzip":24523,"pcpcounty":"","pcpid":"","pcpname":"CARILION CLINIC FAMILY MEDICIN","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ALLEGHANY","aligned":"","ano":"","add2":"1356 WICKER LANE","add3":"","madd1":"1356 WICKER LANE","madd2":"LOT 91","madd3":"","mcity":"VINTON","mstate":"VA","mzip":"24179-6193","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.13","J44.9","E11.9","I10","I25.9","F17.210","Z79.4","R68.89","M25.562","V89.9XXA","R10.12","R11.2","R19.7","F10.10","E11.22","I12.9","N18.9","K85.90","R10.32","R10.30","T81.506A","T88.8XXA","X58.XXXA","R07.89","R07.9","R11.0","N17.9","R06.02","R10.9","T78.1XXA","T78.40XA","R10.819","R53.1","K85.20","Y90.6","F10.188","E10.9","E78.5","Z87.442","F17.200","K21.9","F32.9","Z88.6","F12.10","F41.1","G89.29","R10.84","E10.649","R11.10","E16.2","R10.11","Z87.19","Z09","K86.1","I25.89","Z90.49","K85.80","K29.00","K29.70","F41.9","M25.531","W19.XXXA","S63.501A","Y93.9","Y92.9","F31.9","R55","Z45.09","F10.129","E87.6","F10.920","I45.81","R94.31","E86.0","R10.10","E53.8","F10.11","N20.0","E11.649","Z72.0","I49.9","J44.1","Z87.891","R09.02","R05","R10.31","M47.812","M47.816","M54.2","M54.32","L03.213","L03.211","K02.9","R22.0","K86.0","Z20.822","K04.7","F39","N32.89","Y90.9","I25.2","M54.9","F12.20","Z64.4","Z62.810","Z65.8","Z72.9","R00.2","R06.00","K52.9","F10.20","D69.6","K29.20","R63.4","D72.829","I49.5","R00.1","Z82.49","Z53.09","K30","K22.8","B96.81","K29.60","Z53.8","R00.0","Z79.899","R63.0","R39.12","V29.9XXA","S20.211A","M79.642","Y92.410","S60.512A","S69.92XA","Z23","J45.20","Z53.29","Z87.11","Z83.3","F43.9","K52.89","A41.9","J96.01","D75.1","J45.901","K76.0","R16.0","F31.81","F25.9","Z71.6","K92.1","R94.5","K29.50","R06.03","R06.1","Z87.898","J98.4","R89.9","R30.0","R82.90","F41.0","R93.41","Z53.21","G43.A1","F31.89","F12.90","Z91.14","F19.90","Z88.8","T38.3X6A","R31.9","W18.40XA","Y92.480","M25.462","S76.312A","F12.188","N39.0","Z86.59","R93.3","R10.816","R93.421","I49.8","E83.42","D51.9","J45.40","Z79.51","F19.10","F60.2","H55.09","G43.109","G43.809","R42","K27.9","N28.9","N13.2","N20.1","J45.909","N23","R07.2","E78.00","G47.00","L30.9","R50.9","R10.811","R10.812","E11.43","K31.84","I11.9","Z72.89","K59.00","G43.A0","Z79.1","S20.219A","S39.91XA","S29.9XXA","Z51.89","R07.81","J43.9","M54.5","M25.552","T14.90XA","S89.92XA","S80.02XA","V03.90XA","V03.99XA","M23.90","M22.2X2"],"date":["2022-03-09","2022-03-09","2022-03-09","2022-03-09","2020-01-05","2022-03-09","2020-10-15","2021-02-10","2020-01-15","2020-01-15","2022-02-04","2022-03-09","2022-03-09","2021-12-01","2020-01-30","2020-01-30","2020-01-30","2021-09-08","2020-08-25","2020-01-30","2020-01-30","2020-01-30","2020-01-30","2022-02-14","2022-02-14","2021-03-11","2020-06-10","2020-10-06","2021-10-11","2020-02-23","2020-02-24","2020-02-23","2020-02-24","2022-02-05","2021-12-01","2020-06-10","2022-02-14","2022-02-14","2022-03-09","2022-02-14","2020-03-13","2020-04-09","2021-01-30","2021-06-28","2020-03-10","2020-04-27","2021-09-10","2020-03-19","2020-07-06","2021-06-28","2021-09-10","2022-03-09","2020-03-20","2022-02-14","2022-02-05","2022-02-05","2020-03-22","2020-07-07","2021-09-10","2020-04-09","2020-05-11","2020-05-11","2020-05-11","2020-05-11","2020-05-11","2021-11-30","2021-08-10","2020-05-26","2020-06-04","2022-03-09","2020-06-04","2020-06-04","2021-06-27","2020-06-11","2022-03-09","2021-07-02","2021-11-30","2021-06-27","2021-11-15","2021-11-30","2021-06-27","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2021-01-31","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2021-01-31","2021-01-31","2021-01-31","2021-01-30","2021-01-30","2021-01-30","2021-01-30","2021-05-07","2021-02-10","2021-03-11","2022-03-09","2021-03-11","2021-05-05","2021-05-05","2021-05-05","2021-05-05","2021-05-05","2021-10-01","2022-01-13","2021-09-10","2021-06-28","2021-06-28","2021-06-27","2021-06-28","2021-12-01","2021-11-30","2022-02-01","2021-11-30","2021-09-08","2021-09-08","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-11-15","2022-02-04","2021-10-11","2021-10-11","2021-10-25","2021-10-25","2021-10-25","2021-10-25","2021-10-25","2021-10-25","2021-12-27","2022-01-13","2022-02-04","2022-02-05","2022-02-05","2022-02-14","2019-01-11","2019-01-11","2019-01-15","2019-01-15","2019-01-11","2019-01-15","2019-01-15","2019-01-11","2019-05-14","2019-01-12","2019-01-15","2019-01-13","2019-01-15","2019-01-16","2019-01-16","2019-01-16","2019-01-16","2019-02-01","2019-05-21","2019-02-13","2019-03-23","2019-03-07","2019-07-19","2019-08-25","2019-03-23","2019-11-21","2019-03-23","2019-03-23","2019-03-23","2019-03-27","2019-06-20","2019-04-29","2019-04-29","2019-04-29","2019-05-02","2019-05-13","2019-05-13","2019-05-13","2019-05-13","2019-05-13","2019-05-13","2019-05-14","2019-05-20","2019-05-21","2019-05-21","2019-05-21","2019-08-25","2019-05-21","2019-05-28","2019-05-28","2019-05-28","2019-10-08","2019-05-28","2019-05-28","2019-06-16","2019-06-16","2019-06-16","2019-06-25","2019-07-08","2019-07-08","2019-07-11","2019-07-18","2019-07-19","2019-08-15","2019-08-15","2019-08-25","2019-08-25","2019-08-25","2019-10-08","2019-08-25","2019-09-09","2019-09-09","2019-10-11","2019-10-11","2019-10-11","2019-10-31","2019-11-07","2019-11-21","2019-12-02","2019-12-03","2019-12-03","2019-12-03","2019-12-03","2019-12-05","2019-12-05","2019-12-10","2019-12-18"],"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":[["","42858000101","OXYCODONE","42858000101 OXYCODONE ","10","Select","Select",""],["","68462015713","ONDANSETRON","68462015713 ONDANSETRON ","30","Select","Select",""],["","00002803101","GLUCAGON","00002803101 GLUCAGON ","1","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","57599000101 FREESTYLE    KIT SENSOR","2","Select","Select",""],["","57599157904","FREESTYLE    TES PREC NEO","TES PREC NEO","100","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","68180051802","LISINOP\/HCTZ","68180051802 LISINOP\/HCTZ ","30","Select","Select",""],["","70069000510","CYANOCOBALAM","INJ 1000MCG","4","Select","Select",""],["","59267100002","PFIZER","59267100002 PFIZER ","0.3","Select","Select",""],["","38396050118","KROG","CHW ORANGE","10","Select","Select",""],["","55111015810","OMEPRAZOLE","55111015810 OMEPRAZOLE ","30","Select","Select",""],["","59762040101","SUCRALFATE","TAB 1GM","40","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.50","Select","Select",""],["","00378668910","PANTOPRAZOLE","00378668910 PANTOPRAZOLE ","15","Select","Select",""],["","65862022660","CLARITHROMYC","65862022660 CLARITHROMYC ","28","Select","Select",""],["","00781261305","AMOXICILLIN","00781261305 AMOXICILLIN ","56","Select","Select",""],["","68382004110","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","68462019001","NAPROXEN","TAB 500MG","20","Select","Select",""],["","61442010305","DICLOFENAC","TAB 75MG DR","14","Select","Select",""],["","00527293441","PREDNISONE","TAB 20MG","15","Select","Select",""],["","55111018010","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","10","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","08290305782","3ML","08290305782 3ML ","2","Select","Select",""],["","66685100100","AMOX\/K","66685100100 AMOX\/K ","20","Select","Select",""],["","99073012050","FREESTYLE    TES","TES ","100","Select","Select",""],["","00169706515","GLUCAGEN","INJ HYPOKIT","1","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","57599000200 FREESTYLE    MIS READER","1","Select","Select",""],["","55111046605","METOPROL","55111046605 METOPROL ","30","Select","Select",""],["","57599080000","FREESTY","57599080000 FREESTY ","2","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","12","Select","Select",""],["","00143122710","DICYCLOMINE","00143122710 DICYCLOMINE ","20","Select","Select",""],["","57896038124","ANTI-DIARRHE","TAB 2MG","10","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30.00","Select","Select",""],["","00172572880","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00032301613","CREON","CAP 36000UNT","90","Select","Select",""],["","68382013210","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","65162062750","TRAMADOL","TAB 50MG","12","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","30","Select","Select",""],["","49884046565","CHOLESTYRAM","POW 4GM","60","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","13107003134","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","31722053401","METHOCARBAM","TAB 750MG","20","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"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":""}]}]}