{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"I   AKITALSREDNUAS ","gend":1,"add":"ED 2342RD ATL","city":"ROANOKE","state":"VA","zip":"24017-9998","dob":"1985-07-15","age":"","mstatus":"","insh":"6045110*66","cliId":"","pno":"19\/0456769-5","cno":"","email":"","ename":"","eno":"","pphy":"ISSA, MAYADA H MD","ppno":"540\/224-5170","pcpadd":"3 RIVERSIDE CIR","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24016,"pcpcounty":"","pcpid":"","pcpname":"Carilion Clinic Internal Medicine Riverside 3","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.6","G89.29","E66.01","I10.","Z68.43","G43.009","F31.13","O99.891","R10.2","F39.","F41.9","R44.3","F31.12","M47.812","F41.1","F31.9","F12.10","E66.9","Z98.84","R73.03","M54.5","G56.03","G43.709","F32.9","M54.12","M54.2","G50.1","F51.04","Z68.42","E56.9","Z86.2","E55.9","N91.2","M47.816","G56.01","M79.641","M79.642","F31.11","Z3A.01","M54.9","Z71.3","Z13.21","R63.5","F43.9","F54.","O10.011","O99.341","O02.1","M19.90","F31.2","Z33.1","O26.891","K21.9","L98.7","R87.610","R87.810","M48.02","M54.16","M51.37","Z01.419","Z30.46","Z11.3","M79.643","R87.619","Z01.818","G47.33","Z68.44","Z87.891","K76.0","G47.00","K44.9","R16.0","Z71.89","R79.0","M79.601","Z98.1","E66.2","N76.0","N89.8","B96.89","O80.","Z37.0","O10.913","O99.893","Z79.82","Z79.899","Z3A.31","Z39.1","Z34.82","Z34.83","O13.3","O60.00","O60.10X0","F12.20","Z36.89","Z72.0","Z3A.34","O60.14X0","O10.92","O99.52","O99.844","O99.334","O36.8130","T36.0X5A","F17.200","O60.03","Z3A.29","O26.899","O99.333","F17.210","Z3A.30","M47.22","O26.893","V23.41","M25.851","M17.11","Z3A.22","R51.9","R11.2","Z87.51","V23.89","Z3A.00","Z32.02","N92.3","Z30.09","T50.901A","I16.0","NO DATA","F31.64","J45.909","G25.79","G93.41","R94.31","F41.8","V62.84","F31.5","F32.3","F05.","T14.91XA","Z20.822"],"date":["2020-01-11","2021-09-03","2021-09-03","2022-10-28","2021-09-03","2021-12-07","2021-06-29","2022-05-31","2022-07-26","2021-03-30","2022-11-17","2022-11-17","2021-09-10","2021-09-23","2021-07-26","2022-11-17","2022-11-17","2021-12-14","2022-09-22","2021-12-14","2021-09-03","2022-10-12","2021-01-14","2021-01-22","2020-12-28","2022-05-31","2020-04-04","2020-09-11","2021-10-08","2022-09-22","2022-09-22","2022-09-22","2021-01-15","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2022-10-20","2021-11-30","2022-05-31","2021-10-08","2022-09-22","2020-02-25","2020-02-25","2020-04-15","2021-01-27","2021-01-17","2021-02-15","2021-03-16","2021-05-04","2022-08-01","2021-01-17","2021-06-10","2021-06-30","2021-06-07","2021-06-07","2020-01-16","2020-06-29","2020-09-28","2022-08-24","2022-08-24","2021-01-27","2021-03-11","2022-01-25","2021-07-21","2019-06-04","2019-01-23","2019-06-04","2019-06-04","2019-06-04","2019-06-04","2019-06-04","2019-01-23","2019-01-23","2019-12-20","2022-10-12","2019-04-09","2019-03-21","2022-05-24","2019-03-21","2022-06-25","2022-06-25","2022-05-31","2022-05-31","2022-06-25","2022-05-31","2022-05-31","2022-06-09","2022-06-09","2022-06-09","2022-06-25","2022-06-25","2022-06-25","2022-06-25","2022-06-25","2022-06-25","2022-06-25","2022-06-25","2022-06-25","2022-06-25","2022-06-25","2022-06-25","2022-06-25","2022-06-25","2022-06-25","2022-05-13","2022-05-13","2022-05-24","2022-05-24","2022-05-24","2022-05-24","2022-10-12","2022-05-31","2022-06-07","2022-09-29","2022-09-29","2022-04-01","2022-05-31","2022-04-20","2022-04-22","2022-05-24","2022-06-07","2022-08-24","2022-10-20","2022-10-20","2022-10-28","2022-10-28","2022-10-26","2022-10-30","2022-10-28","2022-10-28","2022-10-28","2022-10-27","2022-10-28","2022-10-28","2022-10-28","2022-10-26","2022-10-31","2022-10-26","2022-10-26"],"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":[["","56151146001","TRUE","TES GLUCOSE","100","Select","Select",""],["","65862049101","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","49483048112","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","00121086802","NYSTATIN","SUS 100000","60","Select","Select",""],["","61874016030","VRAYLAR","CAP 6MG","30","Select","Select",""],["","64011030103","MAKENA","INJ 275MG","4","Select","Select",""],["","33342007207","OLANZAPINE","TAB 20MG","30","Select","Select",""],["","55111053405","DIVALPROEX","TAB 500MG ER","120","Select","Select",""],["","49884012201","LABETALOL","TAB 100MG","60","Select","Select",""],["","11534016503","FOLIC","TAB 1MG","120","Select","Select",""],["","65702028810","FASTCLIX","MIS LANCETS","102","Select","Select",""],["","69584009250","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","65702010710","ACCU-CHEK","SOL ","1","Select","Select",""],["","00555088702","ESTRADIOL","TAB 2MG","10","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","66689002316","HYDROCO\/APAP","SOL 7.5-325","120","Select","Select",""],["","","PREGABALIN","CAP 75MG","","Select","Select",""],["","","PHENTERMINE","TAB 37.5MG","","Select","Select",""],["","","BUPROPN","TAB 150MG XL","","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","TAB ","10","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","59762500801","MISOPROSTOL","TAB 200MCG","8","Select","Select",""],["","00363087310","NICOTINE","LOZ 4MG MINT","108","Select","Select",""],["","33342009441","RIZATRIPTAN","TAB 10MG ODT","9","Select","Select",""],["","62756052269","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","51224000760","METFORMIN","TAB 500MG ER","180","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","6","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","00378727253","NORETHINDRON","TAB 0.35MG","84","Select","Select",""],["","59651000205","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","51759020210","AJOVY","INJ 225\/1.5","2","Select","Select",""],["","","METAXALONE","TAB 800MG","","Select","Select",""],["","68462013901","OXCARBAZEPIN","TAB 600MG","90","Select","Select",""],["","","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","69238117109","DOXEPIN","CAP 50MG","30","Select","Select",""],["","","DIAZEPAM","TAB 2MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","00115166101","PROPRANOLOL","TAB 40MG","60","Select","Select",""],["","","PENICILLN","TAB 500MG","","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","","TOPIRAMATE","TAB 50MG","","Select","Select",""],["","","FUROSEMIDE","TAB 20MG","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","","CHLORHEX","SOL 0.0012","","Select","Select",""],["","","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","FLUZONE","INJ 2020-21","","Select","Select",""],["","","CARVEDILOL","TAB 3.125MG","","Select","Select",""],["","","LISINOPRIL","TAB 10MG","","Select","Select",""],["","47335030888","ZOLPIDEM","TAB 12.5MG","30","Select","Select",""],["","59746038210","HYDROCHLOROT","CAP 12.5MG","30","Select","Select",""],["","00143129005","METHOCARBAM","TAB 500MG","120","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","67877014601","TEMAZEPAM","CAP 15MG","30","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","15","Select","Select",""],["","00536466711","THEREMS-H","TAB ","30","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","30","Select","Select",""],["","00955100410","ENOXAPARIN","INJ 40\/0.4ML","3","Select","Select",""],["","00781507701","LORATADINE","TAB 10MG","30","Select","Select",""],["","00115180301","HYDROXYZ","CAP 25MG","30","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","55111012905","RANITIDINE","CAP 150MG","60","Select","Select",""],["","11917007923","VITAMIN","TAB 100MG","30","Select","Select",""],["","49884071953","TIZANIDINE","CAP 4MG","60","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":""}]}]}