{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAYTON MCMAHON","gend":1,"add":"5115 GREENFIELD STREET SW","city":"ROANOKE","state":"VA","zip":"24018-1600","dob":"2001-04-29","age":"","mstatus":"","insh":4161110,"cliId":"","pno":5405263955,"cno":"","email":"","ename":"","eno":"","pphy":"SMITH JR, DONALD G","ppno":5407257800,"pcpadd":"3707 Brambleton Ave Ste 2, ","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240183658,"pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY MEDICINE BRAMBLETON","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"5115 GREENFIELD STREET SW","madd2":"","madd3":"","mcity":"ROANOKE","mstate":"VA","mzip":"24018-1600","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T19.2XXA","F10.920","G40.89","R41.82","R25.1","R56.9","F10.129","F10.10","F32.0","N92.6","Z30.09","R51","F32.5","E28.2","R07.89","R07.9","J06.9","N91.2","Z36.89","Z3A.12","Z36.3","K92.0","E86.0","R11.10","Z3A.13","O21.1","O22.41","O99.281","O99.611","A74.9","O21.8","R10.12","O21.9","R11.2","O26.891","R10.9","Z33.1","O21.0","K92.2","R16.2","R93.89","E87.6","O26.892","R06.02","O99.512","Z3A.17","O99.891","R00.2","Z3A.20","O35.8XX0","M54.89","Z20.2","N89.8","Z39.1","Z34.82","Z34.83","R03.0","Z71.1","O28.3","Z3A.24","O36.8120","Z3A.27","Z3A.28","O36.8130","Z3A.31","O99.343","F32.9","Z91.81","Z79.899","O26.843","Z3A.35","Z36.85","Z3A.37","O16.3","O13.4","O13.3","O76","Z37.0","Z86.19","O10.013","H04.559","H10.31","R05.9","J34.89","R09.81","Z20.822","M67.441","D22.9","M67.442","K21.9","K82.8","G43.001","G43.009","G43.011","L73.9","R59.1","G43.909","S63.502A","M25.532","W18.2XXA","X50.1XXA","W01.0XXA","T14.90XA","R50.9","R68.89","N93.9","R10.2","F15.129","F19.129","R20.0","R20.2","Y90.6","Z23","R93.5"],"date":["2020-01-14","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-01-22","2020-01-20","2020-01-22","2020-01-22","2020-07-15","2020-02-20","2020-03-06","2020-03-06","2020-07-15","2021-06-17","2021-06-14","2021-05-11","2020-11-13","2021-09-01","2021-05-15","2021-07-07","2021-05-18","2021-05-16","2021-05-15","2021-05-18","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-16","2021-05-15","2021-05-17","2021-05-17","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-06-14","2021-06-17","2021-06-14","2021-06-14","2021-06-14","2021-06-17","2021-07-07","2021-07-07","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-07-20","2021-07-20","2021-11-01","2021-08-04","2021-08-19","2021-08-19","2021-09-01","2021-10-29","2021-09-19","2021-09-19","2021-09-19","2021-09-19","2021-10-29","2021-10-18","2021-10-18","2021-10-25","2021-11-04","2021-11-01","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-02","2021-11-04","2021-12-29","2022-02-10","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2022-03-18","2022-03-18","2022-03-18","2019-01-12","2019-01-13","2019-01-23","2019-02-07","2019-02-07","2019-03-05","2019-03-05","2019-03-12","2019-03-26","2019-03-26","2019-03-26","2019-03-26","2019-03-26","2019-03-26","2019-05-07","2019-05-07","2019-08-14","2019-10-09","2019-09-28","2019-09-28","2019-09-28","2019-09-28","2019-09-28","2019-11-27","2019-11-27"],"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":{"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":[["","00406055201","OXYCODONE","TAB 5MG","20","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","60","Select","Select",""],["","00536132701","ACETAMINOPHE","TAB 325MG","60","Select","Select",""],["","64980051505","OFLOXACIN","DRO 0.3% OP","10.00","Select","Select",""],["","70700011984","ESTARYLLA","TAB 0.25-35","28","Select","Select",""],["","42806071501","BENZONATATE","CAP 200MG","30.00","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20.00","Select","Select",""],["","69238158306","NORLYDA","TAB 0.35MG","84","Select","Select",""],["","68180085713","LEVONOR\/ETHI","TAB ","28","Select","Select",""],["","00781707787","METRONIDAZOL","GEL 0.75%VAG","70","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","68180035103","SERTRALINE","TAB 25MG","30","Select","Select",""],["","59762040101","SUCRALFATE","TAB 1GM","20","Select","Select",""],["","62332000231","FAMOTIDINE","TAB 40MG","10","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","51224012230","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","00363010412","PAIN","TAB 325MG","15","Select","Select",""],["","65862001905","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","10","Select","Select",""],["","65862014836","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","00363022434","ANTACID","CHW 500MG","150","Select","Select",""],["","00555901467","LESSINA","TAB ","28","Select","Select",""],["","00363005002","COMFORT","SUS ANTACID","355","Select","Select",""],["","29300012410","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","59651000205","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","10","Select","Select",""],["","33342008845","RIZATRIPTAN","TAB 10MG","6","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":""}]}]}