{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NILTAKPLED ","gend":1,"add":"S HT82361ES TEERT","city":"ROANOKE","state":"VA","zip":"24013-2708","dob":"1997-01-23","age":"","mstatus":"","insh":"50018737","cliId":"","pno":"0867219276","cno":5405193887,"email":"","ename":"","eno":"","pphy":"COATES, JOSEPH B","ppno":5409859992,"pcpadd":"101 ELM AVE SE,","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":"24013-2222","pcpcounty":"","pcpid":"","pcpname":"CARILION MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"16328TH STREET SE","add3":"","madd1":"16328TH STREET SE","madd2":"","madd3":"","mcity":"ROANOKE","mstate":"VA","mzip":"24013-2708","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05","J02.9","R51.9","R52","O26.892","R10.2","O36.8120","O10.912","O36.8320","Z3A.24","Z79.51","Z79.899","Z87.440","Z34.83","O26.90","O98.813","B37.3","O99.283","E86.0","Z3A.28","O16.3","B37.49","O10.913","O99.343","F31.9","O99.513","J45.909","O40.3XX0","O09.293","Z3A.29","O28.8","Z3A.32","O26.893","Z3A.33","O60.03","Z53.29","Z79.82","Z3A.34","O47.03","O99.213","O24.419","Z36.89","Z34.93","O26.93","Z3A.36","Z87.59","O10.013","O13.3","O47.1","Z3A.37","O10.02","Z3A.39","Z37.0","O10.92","F17.210","O99.344","Z30.430","O71.82","O99.334","F60.9","O99.52","H00.011","S99.921A","Z30.432","M54.50","N30.00","N12","R10.9","R11.2","E11.9","F17.200","N10","R11.0","Z32.00","R25.2","N92.6","Z32.02","M54.2","S19.9XXA","S09.8XXA","S01.511A","M25.512","M25.562","M79.672","V49.50XA","Y92.410","S93.402A","S40.012A","S80.02XA","Z23","S36.529A","S99.912A","V89.2XXA","Z04.1","M79.89","R93.89","S93.492D","R94.6","M79.662","M25.572","R20.2","R20.0","X50.1XXA","X58.XXXA","Z32.01","R09.81","R43.9","Z20.822","R50.9","R05.9","R53.83","M79.10","F32.A","O23.41","E87.6","R10.32","Z3A.01","O26.891","R10.30","O99.281","O99.331","O20.9","N85.4","O99.891","Z34.81","Z3A.09","Z36.82","Z3A.13","O26.811","Z3A.16","Z3A.20","O23.599","Z36.3","Z3A.21","N89.8","Z3A.22","R56.9","R82.71","O99.352","G40.909","O23.92","O99.332","O99.512","Z3A.49","R94.31","Z3A.26","O26.852","O47.02","O99.333","O26.899","Z3A.31","Z72.0","Z03.71","Z3A.00","R03.0","O36.5990","Z86.32","Z39.1","Z34.82","O21.2","R19.7","R11.10","O80","O99.354","G80.9","F44.81","H66.93","Z30.42","H53.149","H66.003","R30.0","G43.909","J06.9","R09.82","Z87.09","H93.11","H90.11","H10.32","I10","R07.89","R55","N76.0","R10.84","R35.0","K64.9","Z11.3","L05.01","L02.92"],"date":["2021-01-08","2022-12-30","2023-02-17","2022-03-05","2022-07-03","2023-04-15","2022-06-02","2022-07-03","2022-06-02","2022-05-21","2021-01-18","2023-03-23","2021-04-09","2022-08-11","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2022-06-15","2021-03-26","2021-02-16","2021-04-09","2022-08-11","2022-08-20","2022-08-18","2023-03-23","2021-04-30","2022-06-15","2021-02-25","2022-08-18","2022-07-15","2022-08-18","2021-03-29","2021-03-25","2022-07-14","2022-07-14","2021-03-26","2022-07-14","2021-03-29","2022-08-18","2022-06-29","2022-08-11","2021-04-09","2022-08-11","2022-08-11","2021-04-09","2021-04-14","2021-04-21","2022-08-21","2021-04-30","2021-04-30","2022-08-21","2021-04-30","2023-03-23","2022-08-20","2021-04-30","2021-04-30","2022-08-20","2021-04-30","2022-08-20","2021-06-05","2021-08-02","2021-08-05","2021-10-06","2021-10-05","2021-10-06","2023-05-11","2023-05-06","2022-01-19","2023-05-17","2021-10-06","2021-11-21","2021-11-21","2021-11-21","2023-02-14","2021-11-24","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-12-29","2021-11-30","2021-11-30","2021-12-29","2021-11-30","2021-11-30","2022-06-15","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-12-29","2021-12-21","2021-12-08","2021-12-21","2021-12-29","2021-12-29","2021-12-29","2021-12-29","2021-12-29","2021-12-29","2022-01-01","2022-12-30","2022-01-14","2022-12-29","2022-12-30","2022-12-30","2022-01-14","2022-12-29","2022-01-14","2022-01-19","2022-01-19","2022-01-19","2022-01-19","2022-01-19","2022-01-19","2022-01-19","2022-03-02","2022-01-19","2022-01-19","2022-01-19","2022-02-02","2022-02-02","2022-03-02","2022-03-02","2022-03-02","2022-03-30","2022-04-21","2022-04-21","2022-04-29","2022-04-29","2022-07-15","2022-05-05","2023-04-06","2022-05-21","2022-07-03","2023-05-06","2022-05-21","2022-05-21","2022-07-03","2022-05-21","2022-05-21","2022-07-03","2022-07-03","2022-06-08","2022-08-11","2022-06-30","2022-07-14","2023-03-23","2022-07-14","2022-07-14","2022-08-10","2022-08-11","2022-08-20","2022-08-11","2022-08-11","2022-08-18","2022-08-18","2023-05-06","2022-08-21","2022-08-20","2022-08-20","2022-08-20","2022-08-23","2022-10-05","2022-11-24","2022-12-15","2022-12-29","2023-02-17","2022-12-30","2022-12-30","2022-12-30","2023-01-17","2023-01-17","2023-01-24","2023-03-23","2023-03-23","2023-03-23","2023-04-15","2023-05-06","2023-05-06","2023-05-11","2023-05-11","2023-05-17","2023-05-17"],"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":[["","68180012202","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","10","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","6.7","Select","Select",""],["","70436015542","PROMETHAZINE","SOL DM","120","Select","Select",""],["","42806071505","BENZONATATE","CAP 200MG","30","Select","Select",""],["","66993037179","MEDROXYPR AC","INJ 150MG\/ML","1","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","69097083305","SERTRALINE","TAB 25MG","30","Select","Select",""],["","13668013501","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","00143924920","AMOX\/K CLAV","TAB 875-125","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":[]}},{"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":""}]}]}