{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   YENDISNOTLIH W","gend":0,"add":"H ENIP 503DAOR WOLLO","city":"CHRISTIANSBURG","state":"VA","zip":"24073-9998","dob":"1961-03-08","age":"","mstatus":"","insh":"2502210*19","cliId":"","pno":"93\/0452232-1","cno":"540\/391-2322","email":"","ename":"","eno":"","pphy":"KELLY, DANIEL R MD","ppno":"540\/731-3200","pcpadd":"SUITE 120 701 RANDOLPH ST","pcpcity":"RADFORD","pcpstate":"VA","pcpzip":24141,"pcpcounty":"","pcpid":"","pcpname":"Carilion Family Medicine Radford","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"","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":["M54.16","G47.33","F41.0","F41.1","F51.05","F99.","F13.20","R94.31","E66.9","Z68.30","G47.09","F17.200","I10.","Z23.","E78.5","R73.03","J44.9","F51.04","G89.29","M54.5","M51.16","R29.898","B19.20","K21.9","Z99.89","Z01.818","Z79.899","Z79.82","F31.81","Z86.19","K74.0","M47.26","M51.36","M47.816"],"date":["2020-04-28","2021-11-18","2022-04-06","2022-04-06","2021-09-29","2021-09-29","2022-04-06","2021-08-25","2021-10-27","2021-10-27","2022-04-06","2022-04-06","2022-02-24","2022-02-24","2022-02-24","2022-02-24","2022-02-24","2022-02-24","2020-07-30","2020-03-04","2020-05-04","2020-02-19","2020-06-29","2021-05-27","2021-05-27","2020-06-06","2020-07-29","2020-04-02","2020-04-07","2020-07-09","2020-07-09","2020-01-22","2020-07-30","2020-07-30"],"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":[["","51672400405","NORTRIPTYLIN","CAP 75MG","60","Select","Select",""],["","60505476606","APO-VARENICL","TAB 1MG","60","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","00536589588","NICOTINE","DIS 14MG\/24H","28","Select","Select",""],["","51991070610","ALPRAZOLAM","TAB 1MG","60","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","16729004417","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","43547035611","LISINOPRIL","TAB 40MG","90","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","59779008002","ATHLETE","CRE 0.01","30","Select","Select",""],["","29300014801","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","4","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","60","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","61442010310","DICLOFENAC","TAB 75MG DR","14","Select","Select",""],["","43547039950","CYCLOBENZAPR","TAB 5MG","20","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","2","Select","Select",""],["","00781502207","METHYLPRED","TAB 4MG","21","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","68462022301","LITHIUM","TAB 300MG ER","60","Select","Select",""],["","55111053401","DIVALPROEX","TAB 500MG ER","60","Select","Select",""],["","00006003330","BELSOMRA","TAB 10MG","30","Select","Select",""],["","70710134403","RAMELTEON","TAB 8MG","30","Select","Select",""],["","59651017301","DOXEPIN","CAP 10MG","30","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","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":""}]}]}