{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   REFINNEJKCIMROCCM E","gend":1,"add":"AC 1931NL OCIL","city":"BLACKSBURG","state":"VA","zip":"24060-9998","dob":"1971-03-16","age":"","mstatus":"","insh":"3468110*50","cliId":"","pno":"44\/0452215-9","cno":"540\/449-5122","email":"","ename":"","eno":"","pphy":"CALL, LINDSAY DO","ppno":"540\/951-0352","pcpadd":"901 PLANTATION RD SUITE 1","pcpcity":"BLACKSBURG","pcpstate":"VA","pcpzip":24060,"pcpcounty":"","pcpid":"","pcpname":"Carilion Family Medicine Blacksburg","plan":"OHP","program":"MEDICAID","lob":"M4","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":["D72.829","Z86.39","S92.902A","W01.0XXA","V58.89","NO DATA","K29.70","K44.9","K31.89","D50.9","I12.9","N18.9","D63.1","K59.09","Z79.899","R87.610","R87.810","R63.5","F51.04","G89.21","F41.8","E78.5","J30.89","Z87.19","K59.9","M79.2","Z51.81","E66.9","R07.9","R10.31","E27.9","R74.8","Z01.818","M79.672","S93.325A","N20.0","R10.9","R30.0","R07.89","R11.2","R10.84","R19.7","R53.81","D72.825","E79.0","R20.2","R20.0","G43.909","K21.0","N91.2","G43.709","Z01.810","I45.89","R94.31","Z23.","K04.7","K59.00","R10.11","R11.0","K92.89","R23.2","N95.1","Z86.69","S93.122A","S93.125A","S93.622A","G89.18","R31.9","G47.00","Z91.030","Z12.11","K63.5","K58.1","R41.82","K52.9","Z20.822","G43.109","Z01.812","Z01.411","Z12.31","R10.2","G89.29","N92.0","N94.6","S92.325A","S92.335A","S92.345A","W10.8XXA","R93.3"],"date":["2021-08-25","2020-12-30","2020-09-15","2020-09-15","2020-12-01","2022-05-20","2020-11-19","2020-11-19","2021-10-01","2021-10-01","2020-11-19","2020-11-19","2020-11-19","2021-09-28","2021-10-15","2021-10-14","2021-10-14","2022-05-20","2022-08-24","2022-05-20","2022-06-29","2022-08-24","2022-05-20","2022-05-20","2022-05-20","2022-08-24","2022-05-20","2022-05-20","2021-08-25","2021-09-28","2021-08-25","2021-08-25","2020-10-17","2021-02-16","2021-02-16","2021-09-08","2021-04-22","2021-08-13","2021-07-31","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-09-08","2021-10-21","2021-10-21","2020-03-03","2020-03-03","2020-03-03","2021-09-09","2020-10-15","2020-10-15","2020-10-15","2021-09-14","2021-09-14","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2022-08-24","2022-08-26","2022-08-24","2020-10-22","2020-10-22","2020-10-22","2020-10-22","2021-05-26","2022-06-29","2021-05-26","2021-10-01","2021-10-01","2020-06-10","2020-10-25","2021-07-31","2021-07-31","2022-06-29","2020-11-18","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2021-09-28"],"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":[["","55111018010","TIZANIDINE","TAB 4MG","45","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","43598051030","ESOMEPRA","CAP 40MG DR","60","Select","Select",""],["","00527512570","LACTULOSE","SOL 10GM\/15","3600","Select","Select",""],["","51991074710","DULOXETINE","CAP 30MG","270","Select","Select",""],["","69097094307","GABAPENTIN","CAP 300MG","120","Select","Select",""],["","55111046805","METOPROL","TAB 100MG ER","90","Select","Select",""],["","49884068905","METOCLOPRAM","TAB 10MG","120","Select","Select",""],["","54092054701","MOTEGRITY","TAB 2MG","30","Select","Select",""],["","00527185943","SUMATRIPTAN","SPR 20MG\/ACT","6","Select","Select",""],["","64980033912","MAGNESIUM-OX","TAB 400MG","60","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","400","Select","Select",""],["","00115180301","HYDROXYZ","CAP 25MG","60","Select","Select",""],["","62332038031","TEMAZEPAM","CAP 15MG","20","Select","Select",""],["","70710122901","AMITRIPTYLIN","TAB 100MG","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","60258017101","MAG","TAB 400MG","60","Select","Select",""],["","65862029490","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","31722072610","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","00169450114","WEGOVY","INJ 1MG","2","Select","Select",""],["","42806066201","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","1","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00536105227","PEG3350","POW ","1530","Select","Select",""],["","50419049104","CLIMARA","DIS WEEKLY","4","Select","Select",""],["","00456120230","LINZESS","CAP 290MCG","90","Select","Select",""],["","65649000330","TRULANCE","TAB 3MG","30","Select","Select",""],["","00254302902","LUBIPROSTONE","CAP 24MCG","60","Select","Select",""],["","64980052810","SODIUM","TAB 650MG","360","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","10","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","57237008663","RIZATRIPTAN","TAB 10MG ODT","12","Select","Select",""],["","52268010001","GOLYTELY","SOL ","8000","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","55566670001","CLENPIQ","SOL ","320","Select","Select",""],["","58914017014","CARAFATE","SUS 1GM\/10ML","400","Select","Select",""],["","55513084101","AIMOVIG","INJ 70MG\/ML","1","Select","Select",""],["","59762232201","ELETRIPTAN","TAB 40MG","12","Select","Select",""],["","00049234045","RELPAX","TAB 40MG","12","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","42","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","15","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","50458058030","XARELTO","TAB 10MG","21","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","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":""}]}]}