{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RAMONA   R WILSON","gend":1,"add":"922   BLANKENSHIP ROAD                                      ","city":"MARTINSVILLE                  ","state":"VA","zip":"24112-2138","dob":"1969-04-16","age":"","mstatus":"","insh":6852622,"cliId":"","pno":2762247403,"cno":2766322005,"email":"","ename":"","eno":"","pphy":"LANGER, NATHAN E                                            ","ppno":2766667827,"pcpadd":"320 Hospital Dr                                             ,                                                            ","pcpcity":"Martinsville                  ","pcpstate":"VA","pcpzip":241121900,"pcpcounty":"","pcpid":"","pcpname":"CARILION MEDICAL ASSOCIATES MARTINSVILLE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"922   BLANKENSHIP ROAD                                      ","add3":"","madd1":"922   BLANKENSHIP ROAD                                      ","madd2":"APT 3                                                       ","madd3":"","mcity":"MARTINSVILLE                  ","mstate":"VA","mzip":"24112-2138","pcpfaxno":"(276) 634-0379","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N18.3","E03.9","E11.9","I10","E87.6","M79.605","M79.652","G62.9","Z79.84","Z79.899","Z88.0","Z91.013","Z88.8","G47.30","E66.9","E78.5","D48.5","L82.1","L91.9","M79.644","S63.621A","W19.XXXA","M25.562","S69.91XD","W19.XXXD","M17.12","M65.312","S63.601A","G47.33","R52","M65.311","M79.89","G56.00","G89.29","K42.9","K76.0","R10.32","K52.9","E08.42","R10.9","M54.5","K57.92","U07.1","J12.89","J96.01","Z68.41","E11.65","E11.42","J18.9","M79.7","E66.09","Z79.82","Z79.891","Z20.828","J18.8","T36.8X5A","R53.1","J13","J96.00","B97.29","R21","L29.9","N18.30","G25.82","R25.2","R55","L23.9","R60.9","Z90.49","Z90.89","L50.6","H25.813","Z12.31","H10.33","H57.11","R26.89","R29.898","K59.09","T78.3XXA","H10.45","R22.0","H57.89","H10.13","E11.40","Z79.01","R07.9","N63.0","Z86.16","N63.20","D24.1","N63.11","R92.8","N64.89","Z11.1","Z23","L50.9","D48.61","E66.01","N63.10","T78.00XA","L50.8","H57.13","Z91.09","T78.00XD","L25.9","L81.8","J02.9","T78.40XA","R09.89","Z12.39"],"date":["2020-01-20","2022-10-18","2022-10-18","2022-10-18","2020-12-05","2020-01-22","2020-01-22","2021-03-23","2021-10-08","2021-10-08","2022-05-16","2022-05-16","2022-05-16","2022-05-17","2020-06-09","2022-10-18","2020-06-10","2022-03-02","2022-03-02","2020-07-23","2020-06-18","2020-07-23","2020-06-30","2020-06-30","2020-06-30","2020-07-15","2020-07-15","2020-07-23","2022-09-01","2020-07-16","2020-07-23","2020-07-23","2020-09-02","2020-09-02","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-30","2021-05-20","2020-11-23","2020-12-15","2020-12-14","2020-12-03","2021-10-08","2020-12-02","2020-12-02","2020-11-26","2022-05-16","2020-11-26","2020-11-26","2020-11-26","2020-11-26","2020-11-26","2020-11-26","2020-11-26","2020-12-05","2020-12-05","2020-12-03","2021-02-08","2022-07-05","2022-10-18","2022-03-07","2021-04-15","2021-04-15","2021-05-20","2022-10-17","2021-09-05","2021-09-05","2021-05-20","2021-06-17","2021-06-28","2021-07-04","2022-01-31","2021-07-26","2021-07-26","2021-08-27","2022-10-17","2022-01-03","2021-09-05","2022-01-31","2021-09-05","2022-05-16","2021-09-05","2021-09-11","2021-09-11","2022-01-03","2021-09-11","2021-10-08","2021-10-08","2021-10-08","2021-09-15","2021-09-30","2022-10-18","2021-09-30","2021-10-05","2021-10-08","2021-10-08","2022-01-11","2021-11-23","2022-01-03","2022-01-03","2022-07-05","2022-05-31","2022-05-31","2022-05-16","2022-05-16","2022-05-16","2022-10-18"],"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":[["","00169406012","VICTOZA","INJ 18MG\/3ML","6","Select","Select",""],["","","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","90","Select","Select",""],["","81131038680","RELION","MIS 31GX6MM","50","Select","Select",""],["","","EUTHYROX","TAB 50MCG","30","Select","Select",""],["","68645058459","METFORMIN","TAB 1000MG","60","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","00781518192","LEVOTHYROXIN","TAB 50MCG","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00054418325","DEXAMETHASON","TAB 2MG","10","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","90","Select","Select",""],["","00093720198","PRAVASTATIN","TAB 20MG","90","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","49281040020","ADACEL","INJ ","0.5","Select","Select",""],["","16729017317","AMITRIPTYLIN","TAB 50MG","30","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","60","Select","Select",""],["","14539067401","HYDROXYZ","CAP 25MG","15","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","64980028005","GLIPIZIDE","TAB 5MG","90","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","30","Select","Select",""],["","68382009405","CARVEDILOL","TAB 12.5MG","180","Select","Select",""],["","67877025130","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","3.5","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","20","Select","Select",""],["","76204020030","ALBUTEROL","NEB 0.00083","90","Select","Select",""],["","61314063006","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","50428041670","ALLRGY","TAB 10-240MG","3","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","15","Select","Select",""],["","60505057501","OLOPATADINE","DRO 0.001","5","Select","Select",""],["","00904530780","BANOPHEN","CAP 50MG","30","Select","Select",""],["","00245531911","KLOR-CON","TAB 20MEQ ER","90","Select","Select",""],["","43598029490","PREGABALIN","CAP 100MG","60","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","10","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","12","Select","Select",""],["","00193658621","MICROLET","MIS LANCETS","100","Select","Select",""],["","00193654621","BAYER","MIS LANCETS","100","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0.5","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","28","Select","Select",""],["","51672201002","HC\/ALOE","CRE 0.005","15","Select","Select",""],["","70436000203","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","00093220301","METOCLOPRAM","TAB 10MG","20","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","15","Select","Select",""],["","80681000200","ZINC","TAB 50MG","15","Select","Select",""],["","68180016106","AZITHROMYCIN","TAB 500MG","5","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","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":{"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":""}]}]}