{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEIA WILLIAMS","gend":1,"add":"407 CLEMENT STREET","city":"RADFORD                       ","state":"VA","zip":"24141-1906","dob":"1978-03-15","age":"","mstatus":"","insh":4231587,"cliId":"","pno":5403206554,"cno":"","email":"","ename":"","eno":"","pphy":"KINCAID, SCOTT ALLEN","ppno":5407313200,"pcpadd":"701 Randolph St Ste 120,","pcpcity":"Radford                       ","pcpstate":"VA","pcpzip":241413047,"pcpcounty":"","pcpid":"","pcpname":"CARILION FAMILY MEDICINE RADFORD","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"407 CLEMENT STREET","add3":"","madd1":"407 CLEMENT STREET","madd2":"","madd3":"","mcity":"RADFORD                       ","mstate":"VA","mzip":"24141-1906","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.25","N32.81","S50.862A","M79.604","W57.XXXA","M79.605","K64.8","R68.89","Z01.89","Z79.899","N39.46","Z98.890","M22.42","R14.0","K59.00","R19.7","R12","K62.5","Z12.31","Z80.3","L50.8","R10.10","R11.0","R10.13","F31.9","K21.9","F60.89","F43.10","Z87.891","Z90.49","R10.84","R10.9","F43.21","R45.851","G62.9","K86.1","R45.850","K31.84","F60.3","F43.12","F41.1","G89.29","E55.9","J30.9","F99","Z04.89","F31.62","N93.9","F60.9","F33.1","M54.16","F33.3","L50.9","Z11.59","K44.9","K31.89","K63.5","E66.9","K31.9","Z68.41","F32.9","Z86.14","M47.816","M54.9","M48.061","M51.27","M48.07","M51.26","M54.5","K60.2","K60.1","K64.4","G43.909","M41.9","F41.0","Z91.5","Z87.19","Z88.4","Z01.810","R00.0","Z01.818","M54.40","R94.31","R06.02","R06.01","R60.0","R06.09","R63.5","R07.9","L50.1","L29.9","R07.89","M62.830","M25.512","F41.9","R79.1","R07.2","I10","E78.2","R00.2","D47.2","G47.30","F33.2","I08.1","I31.3","I51.89","R06.00","E88.81","Z01.812","Z20.828","D12.2","K57.30","R20.0","F33.9","Z01.419","R39.15","M76.62","M25.572","G47.33","G47.61","R06.83","G47.00","R53.83","F31.12","M51.16","G47.36","G47.10","E66.01","F41.8","Z79.891","Z79.83","Z79.84","M47.817","M54.42","M51.36","M25.551","M25.552","G43.809","J01.00","Z20.822","Z63.0","L23.9","D64.9","M19.90","Z90.721","Z00.00","R73.03","R79.89","E78.5","Z82.49","H66.002","R05.9","R30.0","R35.0"],"date":["2021-06-01","2021-12-11","2020-01-14","2020-01-14","2020-01-14","2020-01-14","2020-10-19","2020-10-01","2020-01-30","2021-09-22","2020-10-19","2020-02-03","2020-04-14","2021-06-08","2020-10-19","2021-06-08","2020-07-13","2020-10-19","2021-03-25","2020-03-13","2020-09-21","2020-04-03","2020-04-03","2020-04-03","2021-12-30","2021-06-02","2021-08-16","2021-08-31","2021-11-09","2020-09-14","2020-04-03","2020-04-03","2021-06-01","2020-04-14","2020-04-14","2020-04-14","2020-04-14","2020-04-14","2020-07-02","2021-06-01","2021-06-01","2020-09-11","2020-10-19","2020-04-14","2020-04-14","2020-04-21","2021-08-27","2020-05-11","2021-08-31","2021-04-13","2021-06-01","2020-07-02","2020-07-10","2020-08-07","2020-07-13","2020-07-13","2020-10-19","2020-08-14","2020-07-13","2021-08-27","2021-05-11","2021-08-16","2021-11-11","2021-05-17","2021-05-17","2020-07-17","2021-05-17","2021-05-21","2020-07-20","2020-08-14","2020-08-07","2020-08-07","2021-08-16","2021-08-16","2021-08-16","2020-08-07","2020-08-07","2020-08-07","2020-08-07","2020-11-30","2021-08-11","2020-08-13","2020-09-11","2020-10-08","2020-09-11","2021-11-09","2021-11-09","2020-09-11","2020-10-08","2020-09-21","2020-09-14","2020-10-08","2020-09-15","2020-09-14","2021-05-11","2020-09-15","2021-11-09","2021-11-09","2021-08-16","2021-11-09","2021-08-16","2021-12-14","2021-06-01","2020-10-08","2020-10-08","2020-10-08","2020-10-12","2020-10-12","2021-09-08","2020-10-14","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2021-01-06","2021-01-06","2021-01-12","2021-01-26","2021-08-27","2021-03-31","2021-05-11","2021-03-31","2021-03-31","2021-06-09","2021-05-05","2021-05-11","2021-05-11","2021-11-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-11-11","2021-05-17","2021-12-15","2021-05-21","2021-05-21","2021-06-01","2021-06-22","2021-09-08","2021-08-31","2021-08-11","2021-08-16","2021-08-16","2021-08-16","2021-10-14","2021-10-14","2021-10-14","2021-11-09","2021-11-09","2021-12-15","2021-12-15","2021-12-31","2021-12-31"],"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":[["","00093520006","BUSPIRONE","TAB 30MG","63","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","55111025960","ZIPRASIDONE","CAP 80MG","60","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","30","Select","Select",""],["","13107000334","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","65862069730","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","73336007530","GEMTESA","TAB 75MG","30","Select","Select",""],["","68645059459","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","00093406801","PRAZOSIN","CAP 2MG","30","Select","Select",""],["","31722059690","FENOFIBRATE","TAB 145MG","90","Select","Select",""],["","68382007016","PRAVASTATIN","TAB 10MG","90","Select","Select",""],["","00555077902","MEDROXYPR","TAB 10MG","60","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","3","Select","Select",""],["","65162057310","BETHANECHOL","TAB 25MG","120","Select","Select",""],["","16714089803","LORATADINE","TAB 10MG","60","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","90","Select","Select",""],["","68180044601","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","65162068210","PHENAZOPYRID","TAB 200MG","10","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","15","Select","Select",""],["","81131031271","VITAMIN","CAP 5000UNIT","30","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","68645019059","METOPROL","TAB 50MG","180","Select","Select",""],["","60432065104","DOXEPIN","CON 10MG\/ML","118","Select","Select",""],["","81131031282","D3","CAP 2000UNIT","30","Select","Select",""],["","52817023530","RAMELTEON","TAB 8MG","30","Select","Select",""],["","17478076610","PROGESTERONE","CAP 100MG","30","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","90","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","16714008110","HYDROXYZ","TAB 10MG","30","Select","Select",""],["","67877052830","SOLIFENACIN","TAB 10MG","30","Select","Select",""],["","45802006336","TRIAMCINOLON","CRE 0.00025","80","Select","Select",""],["","17478030512","OLOPATADINE","SOL 0.002","2.5","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","11523723403","MIRALAX","POW 3350 NF","238","Select","Select",""],["","31722093612","OMEGA-3-ACID","CAP 1GM","360","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","45802012935","HALOBETASOL","CRE 0.0005","90","Select","Select",""],["","45802086803","POLYETH","POW 3350 NF","510","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","69543021712","MAG","TAB 400MG","180","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4,000.00","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","5","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","12","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","9","Select","Select",""],["","66993068030","OLANZAPINE","TAB 2.5MG","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":[]}},{"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":""}]}]}