{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"E  NIRRADTRAHIWS ","gend":0,"add":"C ELPPIRT 4451 TPA DR KEER","city":"ROCKY MOUNT","state":"VA","zip":24151,"dob":"1965-06-29","age":"","mstatus":"","insh":"85300210*06","cliId":"","pno":"94\/0452263-3","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"540\/484-4800","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":24151,"pcpcounty":"","pcpid":"","pcpname":"Inpatient Carilion Giles Community Hospital","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":["R07.9","I45.10","R94.31","N10.","R65.10","E87.6","N40.1","R39.11","E87.2","R50.9","D72.829","R51.","I10.","G47.33","E11.9","J98.4","E66.9","R26.81","M54.16","M51.37","M47.816","R05.","Z11.52","M25.512","G89.29","M47.817","Z79.899","S16.1XXA","S39.012A","S90.31XA","G44.319","M51.17","NO DATA","R35.0","R19.7","R21.","M25.612","M62.81","E66.01","Z68.42","M51.16","N12.","N40.0","B96.20","M47.26","G43.909","R11.0","Z20.822","Z20.828","R06.02","Z01.818","R19.5","R52.","G44.89","L02.31","F41.1","R07.89","M79.662","E03.9","E11.40","E78.5","J45.909","Z86.16","Z79.82","R53.83","N20.0","N39.0","E78.2","L05.91","Z23.","K56.7","Z68.43","K91.89","K21.9","K44.9","Z82.49","E11.8","G47.39","N39.41","N52.9","I20.0","R51.9","R09.81","R09.02","U07.1","R05.9","R42.","R53.1","N17.9","E87.8","E86.0","D50.9","Z87.11","M19.90","R03.1","R73.03","N13.8","S09.90XA","M54.2","V89.2XXA","R10.11","F41.9","M46.96","N13.2","R11.2","D72.825","A41.9","M54.42","I95.9","V58.89","M54.9","Z79.84","N20.1","R34.","E89.0","F41.0","N13.5","G47.30","Z28.310","Z93.6","R10.9","M54.17","R35.1","N23.","E27.8","M51.36","V89.2XXD","R10.32","R30.0","I95.2","M75.102"],"date":["2021-12-31","2021-12-31","2021-12-31","2022-09-01","2020-06-05","2020-06-05","2022-08-26","2020-06-25","2020-06-07","2021-02-01","2021-12-31","2020-06-07","2022-09-01","2022-10-14","2022-09-01","2020-06-08","2020-06-07","2021-03-26","2021-08-04","2022-06-21","2022-10-13","2021-08-27","2021-08-27","2022-06-21","2022-07-30","2021-09-29","2022-09-19","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2020-09-16","2022-08-08","2021-04-24","2022-03-21","2021-04-24","2021-08-11","2021-08-11","2022-07-30","2022-08-26","2020-02-07","2022-08-05","2022-07-29","2020-06-25","2022-06-21","2021-02-01","2021-02-01","2021-12-31","2021-12-31","2021-12-31","2022-03-27","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-06-24","2021-12-31","2021-12-31","2022-08-14","2022-08-14","2022-08-14","2022-08-14","2021-12-31","2022-10-13","2021-12-31","2022-09-01","2022-07-29","2020-12-14","2020-09-14","2020-12-14","2020-03-11","2021-11-19","2020-03-11","2022-07-29","2020-06-05","2020-03-11","2020-06-05","2020-06-05","2021-10-07","2021-10-07","2021-09-30","2021-09-30","2021-09-30","2022-07-29","2022-09-01","2021-12-31","2021-12-31","2021-12-31","2020-06-05","2020-06-05","2020-06-05","2020-06-05","2020-06-05","2020-06-05","2021-02-01","2021-11-19","2022-09-01","2021-12-15","2021-12-15","2021-12-15","2019-06-19","2022-10-13","2019-01-28","2022-08-08","2022-07-29","2022-07-29","2022-07-29","2022-05-05","2022-05-05","2022-06-21","2022-07-30","2022-09-01","2022-08-26","2022-07-29","2022-07-29","2022-07-29","2022-07-29","2022-09-01","2022-07-29","2022-08-08","2022-08-14","2022-10-13","2022-08-09","2022-08-14","2022-11-08","2022-03-07","2022-03-07","2022-07-29","2022-08-14","2022-02-01","2022-03-15"],"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":[["","68180047903","SIMVASTATIN","TAB 20MG","30","Select","Select",""],["","65862000899","METFORMIN","TAB 500MG","180","Select","Select",""],["","24979002907","DILTIAZEM","CAP 300MG ER","90","Select","Select",""],["","68382014005","TOPIRAMATE","TAB 100MG","60","Select","Select",""],["","00904759160","FEROSUL","TAB 325MG","60","Select","Select",""],["","68382013210","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","31722053301","METHOCARBAM","TAB 500MG","90","Select","Select",""],["","","GABAPENTIN","CAP 100MG","","Select","Select",""],["","00832003810","OXYBUTYNIN","TAB 5MG","90","Select","Select",""],["","68180051703","LISINOPRIL","TAB 40MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","7","Select","Select",""],["","55111064505","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","15","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","10","Select","Select",""],["","16729009015","FINASTERIDE","TAB 5MG","30","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","49281042250","FLUZONE","INJ 2022-23","0","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","31722095801","BENZONATATE","CAP 200MG","30","Select","Select",""],["","00904759180","FERROUS","TAB 325MG","60","Select","Select",""],["","00469260230","MYRBETRIQ","TAB 50MG","30","Select","Select",""],["","00527169501","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","68382004110","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","62037060090","CARTIA","CAP 300\/24HR","30","Select","Select",""],["","00143211205","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","68462057565","HC","CRE 0.002","15","Select","Select",""],["","63824000815","MUCINEX","TAB 600MG ER","30","Select","Select",""],["","00536116361","MUCUS","TAB 600MG ER","30","Select","Select",""],["","55111018010","TIZANIDINE","TAB 4MG","5","Select","Select",""],["","","AFRIN","SPR 0.0005","","Select","Select",""],["","","ALLERGY","TAB 4MG","","Select","Select",""],["","","ALLER-CHLOR","TAB 4MG","","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","PENICILLN","TAB 500MG","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","","LEVOFLOXACIN","TAB 750MG","","Select","Select",""],["","","CLINDAMYCIN","CAP 150MG","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}