{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ABDUL   RAHMAN NAHIBKHIL","gend":0,"add":"5031 BRITANEY ROAD                                          ","city":"ROANOKE                       ","state":"VA","zip":"24012-8551","dob":"1954-07-03","age":"","mstatus":"","insh":10037670,"cliId":"","pno":5409772004,"cno":5409772004,"email":"","ename":"","eno":"","pphy":"GREGORY, BRADEN A                                           ","ppno":"","pcpadd":"2145 Mount Pleasant Blvd SE,Salem Family Clinic","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240143632,"pcpcounty":"","pcpid":"P0117333","pcpname":"CARILION FAMILY MEDICINE SOUTHEAST FAMILY MEDICAL","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"APARTMENT A                                                 ","add3":"","madd1":"5031 BRITANEY ROAD                                          ","madd2":"APARTMENT A                                                 ","madd3":"","mcity":"ROANOKE                       ","mstate":"VA","mzip":"24012-8551","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","K60.3","H40.013","H04.123","H25.13","E11.65","D50.9","E04.2","E29.1","E55.9","E78.5","Z12.5","J10.1","R50.9","J06.9","M17.11","M19.011","I10","E11.51","M54.5","M25.511","Z23","M25.561","M75.41","G89.29","M25.562","E11.40","H47.233","Z79.84","M25.512","M54.16","M10.9","M19.072","M79.675","M79.89","M19.90","M17.0","D17.79","M23.42","M79.606","E11.49","M1A.3720","M67.449","E29.0","D51.0","H10.45","I25.10","M79.671","N40.1","E53.8","M79.672","R33.8","R05","R09.89","Z87.891","Z02.9","J01.10","M67.442","J84.9","R91.8","M18.12","M79.645","I51.7","R53.83","H04.201","H25.013","H11.051","H11.042","R35.0","M54.9","R20.0","R35.1","R07.9","I44.5","R00.2","R94.31","R01.1","M25.661","M25.662","M25.611","M62.81","K59.01","K59.09","E66.9","K61.1","R60.9","Z20.822","K61.2","Z79.82","K61.0","R45.4","M17.12","E11.319","L03.90"],"date":["2021-06-14","2021-06-04","2021-06-14","2019-12-16","2021-06-14","2020-03-12","2021-11-11","2021-08-05","2021-11-11","2021-11-11","2021-04-22","2020-03-12","2019-02-25","2019-02-25","2020-08-06","2021-08-10","2021-08-10","2021-08-05","2020-01-23","2019-08-22","2021-08-10","2021-11-11","2021-08-10","2021-01-13","2021-08-10","2021-08-10","2021-04-22","2021-06-14","2021-06-03","2021-08-10","2020-03-03","2020-04-13","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2021-06-24","2020-02-27","2021-06-24","2020-02-27","2020-11-11","2020-03-03","2020-03-03","2020-03-12","2021-11-11","2021-06-14","2020-06-18","2020-07-01","2021-01-13","2021-06-18","2020-07-01","2020-07-01","2020-11-11","2020-09-23","2020-08-06","2020-08-06","2020-08-11","2020-09-15","2020-08-27","2020-08-27","2020-09-15","2020-09-15","2020-09-23","2021-08-10","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-02-16","2021-08-10","2021-05-20","2021-06-03","2021-06-03","2021-06-03","2021-06-03","2021-06-03","2021-06-04","2021-06-18","2021-06-18","2021-11-11","2021-10-08"],"priorHcc":["","","","","","",null,"",null,null,"","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","57237001401","TAMSULOSIN","0.4MG","30","Select","Select",""],["","68382072116","NATEGLINIDE","60MG","405","Select","Select",""],["","10006073035","VITAMIN","100MCG","30","Select","Select",""],["","00193731221","CONTOUR","NEXT","100","Select","Select",""],["","00254200801","COLCHICINE","0.6MG","30","Select","Select",""],["","67877057305","BENZONATATE","100MG","30","Select","Select",""],["","65162019050","NAPROXEN","500MG","30","Select","Select",""],["","70377000315","SIMVASTATIN","20MG","30","Select","Select",""],["","69680011225","CYANOCOBALAM","1000MCG","1","Select","Select",""],["","31604002576","MAGNESIUM","400MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","49483060250","IBUPROFEN","400MG","21","Select","Select",""],["","00904671980","ACETAMINOPHEN","B 325","60","Select","Select",""],["","50428919047","DIGES","250MG","20","Select","Select",""],["","00536100901","FERROUS","325MG","30","Select","Select",""],["","50428006520","CVS","400UNIT","60","Select","Select",""],["","00093727298","PIOGLITAZONE","30MG","90","Select","Select",""],["","68382076010","METFORMIN","1000MG","180","Select","Select",""],["","69097094312","GABAPENTIN","300MG","60","Select","Select",""],["","00093227534","AMOX\/K","875-125","20","Select","Select",""],["","69842093108","ACETAMINOPHN","500MG","60","Select","Select",""],["","45802028139","TESTOSTERONE","1.62%","37.5","Select","Select",""],["","00597015330","JARDIANCE","25MG","30","Select","Select",""],["","10006073038","MAG","400MG","90","Select","Select",""],["","00310610530","ONGLYZA","5MG","30","Select","Select",""],["","60432060816","PROMETHAZINE","6.25\/5ML","240","Select","Select",""],["","45802049383","AMMONIUM","12%","140","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","90","Select","Select",""],["","08290305270","3ML","25GX1\"","12","Select","Select",""],["","59779027408","ASPIRIN","81MG","90","Select","Select",""],["","68180098003","LISINOPRIL","10MG","90","Select","Select",""],["","59267100002","PFIZER","COVID-19","0.3","Select","Select",""],["","24208083060","NEO\/POLY\/DEX","0.1% OP","5","Select","Select",""],["","68180016106","AZITHROMYCIN","500MG","3","Select","Select",""],["","00536124701","SENEXON-S","8.6-50MG","30","Select","Select",""],["","49884093547","DICLOFENAC","1%","100","Select","Select",""],["","51991074890","DULOXETINE","60MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","51991074890","DULOXETINE ","CAP 60MG","30","Select","Select",""],["","50428029464","CVS ","TAB 8.6-50MG","30","Select","Select",""],["","69842093108","ACETAMINOPHN ","TAB 500MG","60","Select","Select",""],["","68382072116","NATEGLINIDE ","TAB 60MG","405","Select","Select",""],["","10006073035","VITAMIN ","TAB 100MCG","30","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","00254200801","COLCHICINE ","TAB 0.6MG","30","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","70377000315","SIMVASTATIN ","TAB 20MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","69680011225","CYANOCOBALAM ","INJ 1000MCG","1","Select","Select",""],["","31604002576","MAGNESIUM ","CAP 400MG","30","Select","Select",""],["","00310610530","ONGLYZA ","TAB 5MG","30","Select","Select",""],["","00597015330","JARDIANCE ","TAB 25MG","90","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","49483060250","IBUPROFEN ","TAB 400MG","21","Select","Select",""],["","00904671980","ACETAMINOPHEN ","TA B 325","60","Select","Select",""],["","50428919047","DIGES ","CAP 250MG","20","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","30","Select","Select",""],["","00093727298","PIOGLITAZONE ","TAB 30MG","90","Select","Select",""],["","68382076010","METFORMIN ","TAB 1000MG","180","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","60","Select","Select",""],["","00093227534","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","59779010112","PAIN ","TAB 500MG","60","Select","Select",""],["","45802028139","TESTOSTERONE ","GEL 0.0162","37.5","Select","Select",""],["","10006073038","MAG ","TAB 400MG","90","Select","Select",""],["","60432060816","PROMETHAZINE ","SYP 6.25\/5ML","240","Select","Select",""],["","45802049383","AMMONIUM ","CRE 0.12","140","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","08290305270","3ML ","MIS 25GX1\"","12","Select","Select",""],["","59779027408","ASPIRIN ","CHW 81MG","90","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","24208083060","NEO\/POLY\/DEX ","SUS 0.1% OP","5","Select","Select",""],["","68180016106","AZITHROMYCIN ","TAB 500MG","3","Select","Select",""],["","00536124701","SENEXON-S ","TAB 8.6-50MG","30","Select","Select",""],["","49884093547","DICLOFENAC ","GEL 0.01","100","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}