{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMY   R SLUSHER","gend":1,"add":"4124 BETHLEHEM CHURCH ROAD","city":"PILOT","state":"VA","zip":"24138-1343","dob":"1983-06-17","age":"","mstatus":"","insh":4100709,"cliId":"","pno":5403201828,"cno":"","email":"","ename":"","eno":"","pphy":"KUIKEN, GARRY","ppno":5407455700,"pcpadd":"249 Franklin Pike SE, ","pcpcity":"Floyd","pcpstate":"VA","pcpzip":240912893,"pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY MEDICINE FLOYD","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APT B","add3":"","madd1":"4124 BETHLEHEM CHURCH ROAD","madd2":"APT B","madd3":"","mcity":"PILOT","mstate":"VA","mzip":"24138-1343","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F43.23","G25.81","R55","E11.65","E78.2","R42","Z82.49","R06.02","Z68.33","E11.9","F43.22","F32.9","M17.0","R06.09","M54.5","G89.29","J20.8","J45.20","M54.16","K21.9","J45.909","Z91.040","E66.01","Z68.39","E55.9","G47.9","F33.9","F41.9","G47.10","F11.10","F12.10","R45.851","R44.0","F31.9","E11.42","Z98.890","Z68.41","J45.30","A60.00","E78.00","H91.90","Z79.51","Z79.84","M17.11","M17.12","Z01.818","Z79.4","Z79.899","M19.90","G43.909","E11.40","M47.26","E66.9","Z01.419","Z12.4","N60.11","N60.12","Z97.5","M47.816","M79.7","M47.817","R13.10","M75.41","M25.562","R13.19","Z83.71","Z12.11","K22.4","K04.7","M51.36","M94.262","X58.XXXA","M79.662","S80.862A","W57.XXXA","Z30.433","M16.11","M16.0","Z01.812","Z20.822","K31.89","K57.30","K22.8","K64.8","K31.9","F17.290","Z30.431","R76.11","B35.3","L72.11","E78.5","F33.0","M65.331","I95.9","L72.0","Z03.89","R53.83","J40","M54.12","G56.03","R68.89","M25.511","F33.1","N60.19","Z68.36","Z80.3","F12.20","Z68.34","G47.30","M50.10","E11.49","Z87.891","M54.42","M54.41","Z12.31","R63.4","M25.571","S82.891A","M25.572","M79.672","M79.671","S93.401A","S93.402A","I95.1","M51.27","M51.16","S86.912A","M25.561","M25.661","R26.2","R06.83"],"date":["2022-03-31","2020-09-03","2021-11-23","2021-09-02","2022-03-23","2022-03-23","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2021-02-19","2021-11-23","2020-10-28","2021-11-15","2020-02-21","2020-03-02","2020-11-24","2020-03-10","2020-03-10","2021-09-17","2022-03-23","2020-04-30","2020-04-30","2020-10-28","2020-04-30","2022-03-23","2020-05-13","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2020-10-28","2020-09-30","2020-10-28","2021-03-11","2020-09-30","2021-03-11","2020-09-30","2020-09-30","2021-03-11","2021-11-22","2021-11-22","2021-01-16","2022-03-23","2021-09-17","2020-08-26","2020-10-28","2020-08-26","2020-09-08","2021-09-17","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2021-03-12","2021-09-17","2021-03-11","2020-10-28","2021-03-11","2020-12-07","2021-01-25","2021-03-11","2021-03-11","2021-03-11","2020-12-15","2021-01-01","2021-01-12","2021-01-21","2021-01-21","2021-01-21","2021-01-30","2021-01-30","2021-02-12","2021-02-26","2021-02-26","2021-03-06","2021-03-06","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-12","2021-06-11","2021-06-16","2021-08-03","2021-12-22","2022-03-23","2021-11-22","2021-12-22","2019-01-10","2019-02-06","2019-12-12","2019-02-13","2019-06-17","2019-04-11","2019-06-12","2019-04-22","2019-08-15","2019-06-11","2019-06-11","2019-06-28","2019-06-18","2019-06-17","2019-06-20","2019-06-20","2019-06-20","2019-06-20","2019-08-06","2019-08-06","2019-06-28","2019-07-02","2019-07-27","2019-07-27","2019-07-27","2019-07-30","2019-07-30","2019-07-30","2019-07-30","2019-08-07","2019-09-23","2019-09-23","2019-09-27","2019-10-15","2019-10-15","2019-10-15","2019-12-12"],"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":[["","23155010210","METFORMIN","23155010210 METFORMIN ","120","Select","Select",""],["","59676036001","ORTHOVISC","INJ 15MG\/ML","12","Select","Select",""],["","00093321915","KETOCONAZOLE","00093321915 KETOCONAZOLE ","15","Select","Select",""],["","68180096301","ALBUTEROL","68180096301 ALBUTEROL ","8.5","Select","Select",""],["","64380074207","BUSPIRONE","64380074207 BUSPIRONE ","180","Select","Select",""],["","70010075401","METHOCARBAM","70010075401 METHOCARBAM ","90","Select","Select",""],["","00597015330","JARDIANCE","00597015330 JARDIANCE ","30","Select","Select",""],["","70436001304","DESVENLAFAX","70436001304 DESVENLAFAX ","30","Select","Select",""],["","00378427677","VALACYCLOVIR","00378427677 VALACYCLOVIR ","30","Select","Select",""],["","33342010215","MONTELUKAST","33342010215 MONTELUKAST ","30","Select","Select",""],["","72205000599","ROSUVASTATIN","72205000599 ROSUVASTATIN ","30","Select","Select",""],["","00185067405","HYDROXYZ","00185067405 HYDROXYZ ","240","Select","Select",""],["","13668000810","ZOLPIDEM","13668000810 ZOLPIDEM ","30","Select","Select",""],["","47335071013","TOPIRAMATE","47335071013 TOPIRAMATE ","60","Select","Select",""],["","00536105227","PEG3350","00536105227 PEG3350 ","510","Select","Select",""],["","00186037020","SYMBICORT","00186037020 SYMBICORT ","10.2","Select","Select",""],["","70954002110","PRAZOSIN","70954002110 PRAZOSIN ","30","Select","Select",""],["","00378668910","PANTOPRAZOLE","00378668910 PANTOPRAZOLE ","30","Select","Select",""],["","62332042771","BENZONATATE","CAP 200MG","30","Select","Select",""],["","00169406013","VICTOZA","00169406013 VICTOZA ","9","Select","Select",""],["","67877022305","GABAPENTIN","67877022305 GABAPENTIN ","90","Select","Select",""],["","57599157701","FREESTYLE    TES PREC NEO","57599157701 FREESTYLE    TES PREC NEO","25","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","57599000101 FREESTYLE    KIT SENSOR","2","Select","Select",""],["","50228014601","HYDROCHLOROT","50228014601 HYDROCHLOROT ","30","Select","Select",""],["","00143980305","DOXYCYCL","00143980305 DOXYCYCL ","20","Select","Select",""],["","50419042301","MIRENA","50419042301 MIRENA ","1","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4.00","Select","Select",""],["","50458014030","INVOKANA","50458014030 INVOKANA ","30","Select","Select",""],["","65862050320","AMOX\/K","65862050320 AMOX\/K ","20","Select","Select",""],["","42806001105","SULINDAC","42806001105 SULINDAC ","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","16729000617","SIMVASTATIN","TAB 40MG","90","Select","Select",""],["","43386031214","GAVILAX","43386031214 GAVILAX ","510","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","70000041503","CLEARLAX","POW ","510.00","Select","Select",""],["","65162090203","ARIPIPRAZOLE","TAB 30MG","30","Select","Select",""],["","51991096257","POLYETH","51991096257 POLYETH ","510","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","57599000200 FREESTYLE    MIS READER","1","Select","Select",""],["","59676058015","JANSSEN","59676058015 JANSSEN ","0.5","Select","Select",""],["","00781577626","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","51991074790","DULOXETINE","CAP 30MG","30","Select","Select",""],["","99073012050","FREESTYLE    TES","TES ","100","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","24","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","30","Select","Select",""],["","86227012105","SURE","MIS 31GX3\/16","100","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","9","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"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":""}]}]}