{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  SILLYHPSIRRAH T ","gend":1,"add":"ARYS 9351EVA ESUC","city":"ROANOKE","state":"VA","zip":"24017-9998","dob":"1965-06-29","age":"","mstatus":"","insh":"68500210*46","cliId":"","pno":"86\/0456225-5","cno":"540\/685-5226","email":"","ename":"","eno":"","pphy":"AUSTIN, ANN ELIZABETH DO","ppno":"540\/224-5170","pcpadd":"3 RIVERSIDE CIRCLE","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24016,"pcpcounty":"","pcpid":"","pcpname":"Carilion Clinic Internal Medicine Riverside 3","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M17.12","M25.362","M25.462","Z72.0","E66.01","M71.21","M67.51","G47.33","R63.4","R80.9","M15.9","Z02.83","R05.8","I10.","R73.03","I08.1","R03.0","E87.6","R06.02","Z87.891","F17.200","F32.4","J44.9","Z12.2","R05.3","Z68.41","R05.","E66.9","G47.00","R09.82","M25.562","F32.2","N39.46","R91.1","G89.29","Z01.818","R06.09","Z86.16","Z12.11","D12.2","K57.30"],"date":["2022-10-10","2020-03-05","2020-03-05","2022-04-18","2022-10-10","2020-03-05","2020-03-05","2022-04-21","2022-04-21","2022-04-21","2022-04-21","2022-04-21","2022-04-21","2022-10-10","2022-08-01","2020-08-04","2020-08-04","2022-10-10","2022-04-18","2020-02-20","2022-10-10","2022-10-10","2022-10-10","2022-10-10","2022-10-10","2022-10-10","2021-07-27","2021-07-27","2022-08-01","2021-07-27","2020-02-06","2020-02-06","2020-02-06","2022-04-18","2020-02-06","2020-08-23","2022-04-18","2022-04-18","2022-09-27","2022-09-27","2022-09-27"],"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":[["","00536589488","NICOTINE","DIS 7MG\/24HR","14","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","90","Select","Select",""],["","10702001601","INDOMETHACIN","CAP 75MG ER","60","Select","Select",""],["","45802086803","POLYETH","POW 3350 NF","510","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","35","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","13668040910","LOSARTAN","TAB 50MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","45","Select","Select",""],["","68180021509","LOSARTAN\/HCT","TAB 50-12.5","30","Select","Select",""],["","69097012805","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","10370010150","BUPROPN","TAB 150MG XL","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}