{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIA   I CARRASQUILLO","gend":1,"add":"32   SIESTA CIRCLE                                          ","city":"MARTINSVILLE                  ","state":"VA","zip":"24112-0381","dob":"1970-11-26","age":"","mstatus":"","insh":4977785,"cliId":"","pno":2763407328,"cno":"","email":"","ename":"","eno":"","pphy":"PALLONE, AMANDA W                                           ","ppno":2766703300,"pcpadd":"1107 Brookdale St # A                                       ,                                                            ","pcpcity":"Martinsville                  ","pcpstate":"VA","pcpzip":241124501,"pcpcounty":"","pcpid":"","pcpname":"CARILION MEDICAL ASSOCIATES MARTINSVILLE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"32   SIESTA CIRCLE                                          ","add3":"","madd1":"32   SIESTA CIRCLE                                          ","madd2":"                                                            ","madd3":"","mcity":"MARTINSVILLE                  ","mstate":"VA","mzip":"24112-0381","pcpfaxno":"(276) 634-0362","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F43.12","Z01.818","D50.9","I12.9","E11.22","N18.9","E11.42","E07.9","E53.8","Z82.49","Z86.73","Z79.02","Z79.82","Z83.3","Z83.49","Z79.84","Z79.899","I69.991","R13.10","I69.928","E11.43","K31.84","Z79.4","K44.9","E78.00","G43.909","F32.9","R13.12","E11.9","E03.9","E11.65","E55.9","E61.1","D51.0","Z12.4","R00.0","E66.01","I63.9","Z12.31","E78.5","I10","Z79.01","R09.89","R06.83","E78.2","R94.31","I63.00","R00.2","G43.001","E11.00","I20.8","R06.09","Z68.42","E11.8","M54.5","G89.29","D64.9","Z80.9","I35.8","I51.7","R06.02","K59.00","I25.10","R68.89","G43.009","G62.9","G47.00","Z13.9","I69.322","E11.21","R80.9","E78.49","R63.0","M48.062","M54.16","G56.03","R07.9","R91.8","R07.89","J98.4","J90","Z23","R45.851","E10.9","G40.909","F33.2","I69.259","M53.3","M79.18","N39.0","M47.817","D72.829","F81.9","R73.9","G47.8","E66.9","F91.3","F39","D51.3","F41.1","I13.10","R53.82","Z12.11","Z12.39","I44.5","M54.9","G92.8","G93.41","J96.01","Z20.822","R40.4","R40.20","R09.02","R50.9","T40.421A","N30.00","N17.9","T43.011A","E86.0","G92.9","Y92.019","E83.42","T50.901D","R06.00","T50.901A","F41.9","F33.9","E87.6","R45.4","T88.7XXS","G47.09","F32.A","R53.83","Z79.891","H40.013","H35.372"],"date":["2020-11-30","2020-01-09","2020-01-16","2022-09-19","2022-09-19","2022-09-19","2022-09-19","2022-02-22","2022-02-22","2022-08-31","2022-02-22","2022-09-19","2022-09-19","2022-09-19","2021-11-23","2022-02-22","2022-02-22","2022-09-19","2020-01-27","2020-02-06","2020-01-27","2020-01-27","2020-01-27","2021-08-24","2020-07-31","2021-08-24","2020-01-27","2022-01-13","2020-11-11","2022-02-21","2022-08-31","2022-08-31","2022-08-10","2020-01-29","2020-01-30","2020-02-04","2020-03-05","2022-01-20","2020-05-07","2021-10-12","2022-02-21","2022-08-31","2022-09-19","2020-02-06","2020-04-27","2022-08-31","2021-11-16","2020-11-03","2020-03-11","2022-08-31","2022-08-31","2020-03-04","2022-01-20","2022-01-13","2022-08-31","2021-08-19","2022-08-25","2022-09-19","2020-03-09","2020-03-11","2022-01-20","2020-03-11","2020-05-26","2021-06-15","2021-02-10","2022-08-31","2022-09-19","2022-08-29","2020-11-10","2020-05-07","2022-02-07","2022-02-07","2022-08-31","2020-06-10","2021-09-09","2022-08-25","2020-11-10","2022-02-21","2020-07-31","2020-07-31","2020-07-31","2020-07-31","2020-09-30","2020-10-01","2020-10-01","2020-10-01","2022-08-01","2021-04-06","2022-04-05","2022-08-25","2022-01-20","2022-09-12","2022-09-19","2021-04-06","2020-12-08","2021-04-06","2022-08-29","2022-09-14","2021-04-06","2022-09-19","2022-01-25","2021-07-06","2021-08-03","2021-08-24","2021-08-24","2021-11-16","2022-08-25","2022-01-15","2022-01-13","2022-01-13","2022-01-13","2022-01-13","2022-01-13","2022-01-13","2022-01-13","2022-01-13","2022-01-13","2022-01-20","2022-01-13","2022-01-13","2022-01-20","2022-01-13","2022-01-20","2022-01-20","2022-01-20","2022-01-20","2022-08-01","2022-09-06","2022-02-21","2022-08-01","2022-08-01","2022-08-10","2022-08-31","2022-09-19","2022-09-19","2022-11-01","2022-11-01"],"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":[["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","00169266015","TRESIBA","INJ 100UNIT","12","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","68382013606","LOSARTAN","TAB 50MG","30","Select","Select",""],["","55111025501","CARVEDILOL","TAB 25MG","60","Select","Select",""],["","00378181510","LEVOTHYROXIN","TAB 150MCG","30","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","10135017301","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","69097086107","ZONISAMIDE","CAP 100MG","90","Select","Select",""],["","13668003105","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","00378003201","METOPROL","TAB 50MG","30","Select","Select",""],["","68382076010","METFORMIN","TAB 1000MG","60","Select","Select",""],["","68382080505","TRAZODONE","TAB 50MG","30","Select","Select",""],["","29300013510","CLONIDINE","TAB 0.1MG","90","Select","Select",""],["","29300011101","LAMOTRIGINE","TAB 25MG","15","Select","Select",""],["","77333052010","MELATONIN","TAB 5MG","30","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","8","Select","Select",""],["","68001051800","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","73070010011","INSULIN","INJ 100\/ML","15","Select","Select",""],["","00378047205","DIVALPROEX","TAB 250MG ER","30","Select","Select",""],["","00185041501","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","00093719801","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","00093761356","ARIPIPRAZOLE","TAB 2MG","30","Select","Select",""],["","00378267501","AMITRIPTYLIN","TAB 75MG","30","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","59762502701","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","10135065201","B-12","TAB 1000MCG","60","Select","Select",""],["","00832105515","BACLOFEN","TAB 20MG","60","Select","Select",""],["","51079098520","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","57664013688","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","","NOVOLOG","INJ 100\/ML","10","Select","Select",""],["","08484081028","PRODIGY","MIS 28G","100","Select","Select",""],["","00193730850","BAYER","NE XT 50CT","100","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","00193731150","CONTOUR","TES NEXT","100","Select","Select",""],["","59779043951","CVS","TAB 81MG EC","30","Select","Select",""],["","68682045570","METRONIDAZOL","GEL 0.75%VAG","70","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":{"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":""}]}]}