{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AICIRTAPYTREHGUAD","gend":1,"add":"AOR YTREBIL 0272LEON NADROJ WN D","city":"ROANOKE","state":"VA","zip":"24012-9998","dob":"1959-04-01","age":"","mstatus":"","insh":"16200210*76","cliId":"","pno":"2504553761","cno":"","email":"","ename":"","eno":"","pphy":"PAULEY III, WILLIAM E NP","ppno":"540\/265-1607","pcpadd":"4910 VALLEY VIEW BLVD","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24012,"pcpcounty":"","pcpid":"","pcpname":"LEWIS GALE PHYSICIANS LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","G43.909","Z59.0","J44.9","I10.","F17.210","R51.","T50.911A","N17.0","R57.8","G92.","M62.82","E87.2","E87.1","F19.10","N39.0","G43.709","E86.1","E86.0","A41.9","N17.9","B18.2","R41.0","I95.2","D72.829","R65.21","G93.40","R41.89","B19.20","G62.9","I50.9","R18.8","Z45.2","R79.89","R55.","NO DATA","I73.9","R60.9","I67.1","F14.10","R74.0","R74.8","R11.12","R11.0","Z20.828","K74.60","K62.5","R10.9","K74.69","G43.919","T74.21XA","F32.9","K72.90","F17.200","F33.9","R51.9","R30.0","K04.7","M54.31","M25.551","L60.3","I11.0","K76.6","I50.30","E87.70","F15.10","F12.10","Z88.2","R10.84","R00.0","I49.1","R06.02","R14.0","K70.31","M79.89","K21.9","I12.9","N18.9","R26.2","Z88.5","Z88.8","Z79.1","I13.0","K59.00","Z72.0","Z86.69","K08.9","G43.009","F99.","Z11.52","M79.601","W19.XXXA","Z04.71","R63.4","R63.0","G43.719","K02.9","K08.89","Z76.5","K76.89","G44.89","G89.29","S39.012A","M54.9","F15.20","T76.21XA","S00.83XA","Z91.19","R53.81","F19.94","Z91.14","M25.511","G89.4","H53.8","Z04.89","K22.10","Z86.73","Z87.898","Z79.899","Z83.3","Z83.49","Z82.49","Z84.89","Z59.00","M79.604","G43.011","M79.644","G89.18","R10.31","R07.81","W18.2XXA","Z63.8","R53.1","Z20.822","F19.20","F13.20","F14.20","Z78.9","Z73.9","Z63.9","Z65.8","R46.89","M25.519","Z00.00","G44.329","L03.211","I95.9","I07.1","S52.121A","Z48.03","Z48.813","L03.311","B34.9","K59.09","T14.90XA","M54.41","I51.7","R94.31","R52.","R60.0","R19.00","S30.0XXA","W18.39XA","K56.7","G43.101","S09.90XA","S52.124A","S00.81XA","M54.5","R57.9","F05.","F19.14","R10.30","G43.109","R22.2","S20.221A","M54.6","R76.8","G43.809","S22.31XA","R11.2","K65.2","Z01.818","Z53.20","J43.9","F03.90","R56.9","Z76.89","V62.84","R07.89","F41.9","F02.80","T50.904A","R41.82","G44.209","F33.1","R77.0","Z86.59","R07.82","E87.6","R73.01","B17.10","J06.9","B97.89","F29.","R07.9","K59.03","S22.060A","W01.0XXA","F39.","F60.9","F13.10","F10.20","G43.019","I95.89","N17.8","F60.3","T65.94XA","F41.8","R11.11","Z12.31","Z12.11","Z20.2","R90.89","F19.90","R87.612","M79.661","F06.8","Y04.0XXA","G43.701","V62.85","Z76.0","M54.42"],"date":["2021-11-17","2022-05-19","2021-05-21","2022-07-23","2022-07-23","2022-07-23","2020-09-04","2020-05-06","2020-05-06","2020-05-06","2020-05-06","2020-05-09","2020-05-09","2020-05-07","2020-06-05","2020-09-26","2022-04-12","2020-05-06","2020-05-06","2020-08-05","2020-06-06","2022-04-12","2020-05-07","2020-05-07","2020-05-07","2020-05-07","2020-05-09","2020-05-07","2021-07-08","2020-05-07","2020-09-16","2020-10-08","2020-06-05","2020-06-06","2020-07-24","2022-07-23","2020-09-16","2020-07-16","2021-04-05","2022-04-12","2020-06-05","2020-03-26","2020-04-26","2022-08-06","2020-12-15","2022-05-19","2020-06-11","2021-08-09","2022-04-12","2022-08-06","2021-01-17","2021-01-17","2021-01-17","2022-05-19","2022-10-06","2022-07-23","2021-09-16","2022-03-03","2021-11-17","2021-10-26","2021-10-26","2020-09-16","2020-06-05","2020-06-06","2020-06-05","2020-06-05","2020-07-16","2020-06-05","2020-06-05","2020-06-17","2020-06-17","2020-06-17","2020-06-17","2020-07-22","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2022-05-19","2021-01-14","2020-10-31","2021-01-19","2022-08-06","2021-01-19","2021-01-19","2021-02-26","2021-05-21","2021-07-25","2022-04-12","2021-11-17","2021-12-14","2022-07-23","2022-08-06","2021-01-16","2020-08-21","2021-07-25","2022-07-23","2020-12-23","2022-08-06","2021-01-16","2021-01-17","2021-02-24","2021-02-24","2021-04-23","2021-05-17","2021-05-17","2021-05-21","2021-06-24","2021-06-23","2021-07-23","2021-07-25","2021-07-25","2021-07-25","2022-07-23","2021-07-25","2021-07-25","2021-07-25","2021-07-25","2022-05-19","2021-10-21","2020-03-06","2020-03-06","2020-07-24","2020-08-06","2020-09-26","2020-09-26","2021-02-20","2021-04-21","2021-04-21","2022-01-12","2022-01-12","2022-01-12","2022-10-06","2022-10-06","2022-10-06","2022-10-06","2021-05-17","2021-05-21","2021-06-24","2021-06-24","2020-01-10","2020-05-09","2020-05-07","2020-05-22","2020-09-16","2020-09-16","2020-08-05","2020-09-04","2020-11-03","2021-02-24","2020-02-11","2020-05-04","2020-05-04","2020-06-01","2020-06-01","2020-07-24","2020-12-23","2020-12-23","2021-08-09","2020-01-24","2020-04-17","2020-04-18","2020-04-18","2020-04-18","2020-05-09","2020-05-09","2020-05-09","2020-07-30","2020-07-30","2020-09-04","2020-12-23","2020-12-23","2021-03-11","2020-02-19","2020-04-14","2020-04-26","2020-08-11","2020-11-03","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2021-03-23","2019-06-11","2019-01-28","2019-09-16","2019-03-07","2019-03-30","2019-04-15","2019-06-19","2022-06-21","2019-01-11","2019-03-16","2019-04-16","2019-12-20","2019-12-17","2019-12-20","2019-01-06","2019-01-06","2019-01-11","2019-01-23","2019-02-26","2019-04-14","2019-04-14","2019-01-14","2019-01-14","2019-01-14","2019-02-09","2019-05-10","2019-07-02","2019-07-02","2019-01-12","2019-03-31","2019-03-31","2019-04-17","2019-11-12","2019-11-12","2019-11-12","2019-11-21","2019-01-08","2019-01-08","2019-02-18","2019-03-13","2019-03-13","2019-05-15","2019-12-12","2019-10-12","2022-07-23"],"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":[["","00591336901","BUT\/APAP\/CAF","TAB ","12","Select","Select",""],["","","SPIRONOLACT","TAB 100MG","","Select","Select",""],["","","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","57237004101","PENICILLN","TAB 500MG","28","Select","Select",""],["","68180051703","LISINOPRIL","TAB 40MG","30","Select","Select",""],["","49884028901","MEGESTROL","TAB 20MG","60","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","50428040311","GENTLE","SUP 10MG","8","Select","Select",""],["","50428166371","BISACODYL","SUP 10MG","8","Select","Select",""],["","00904630477","MAG","SOL LEMON","296","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","43386031208","GAVILAX","POW ","238","Select","Select",""],["","62756052169","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","68180044601","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","67877022405","GABAPENTIN","CAP 400MG","90","Select","Select",""],["","57664051083","MIRTAZAPINE","TAB 7.5MG","30","Select","Select",""],["","72626270101","SOFOS\/VELPAT","TAB 400-100","28","Select","Select",""],["","","CONSTULOSE","SOL 10GM\/15","","Select","Select",""],["","61958220101","EPCLUSA","TAB 400-100","28","Select","Select",""],["","00527512570","LACTULOSE","SOL 10GM\/15","900","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","16729020201","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","61442010305","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","60","Select","Select",""],["","59779030602","CVS","POW ","238","Select","Select",""],["","19515081852","FLULAVAL","INJ 2021-22","0","Select","Select",""],["","29300011505","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","10702001250","HYDROXYZ","TAB 50MG","120","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","","BLOOD","MIS MONITOR","","Select","Select",""],["","65162005350","CITALOPRAM","TAB 20MG","7","Select","Select",""],["","","AMLODIPINE","TAB 10MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","AFLURIA","INJ 2020-21","","Select","Select",""],["","","ENSURE","LIQ CHOCOLAT","","Select","Select",""],["","00591530701","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","57664011813","VERAPAMIL","TAB 240MG ER","30","Select","Select",""],["","68382080510","TRAZODONE","TAB 50MG","30","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","30","Select","Select",""],["","00904645780","DOK","CAP 100MG","60","Select","Select",""],["","00054001829","PREDNISONE","TAB 20MG","15","Select","Select",""],["","00597002402","COMBIVENT","AER 20-100","4","Select","Select",""],["","57896062912","GERI-LANTA","SUS ","355","Select","Select",""],["","66993066430","DULOXETINE","CAP 60MG","30","Select","Select",""],["","62756079888","DIVALPROEX","TAB 500MG DR","60","Select","Select",""],["","00093075506","DIFLUNISAL","TAB 500MG","20","Select","Select",""],["","49035011635","STOOL","CAP 100MG","60","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","30","Select","Select",""],["","49035007860","EQ","CAP SOFTENER","60","Select","Select",""],["","24385035640","GNP","SUS ANTI-GAS","360","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","28","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":""}]}]}