{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALICIA GALLIMORE","gend":1,"add":"301   GIVENS LANE                                           ","city":"BLACKSBURG                    ","state":"VA","zip":"24060-2426","dob":"1990-03-18","age":"","mstatus":"","insh":10055563,"cliId":"","pno":5408181686,"cno":5408181686,"email":"","ename":"","eno":"","pphy":"FREEMAN, JEREMY                                             ","ppno":"","pcpadd":"1420 N Main St","pcpcity":"Blacksburg                    ","pcpstate":"VA","pcpzip":240602522,"pcpcounty":"","pcpid":"P0117348","pcpname":"CARILION FAMILY MEDICINE NORTH MAIN","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"LOT 129                                                     ","add3":"","madd1":"301   GIVENS LANE                                           ","madd2":"LOT 129                                                     ","madd3":"","mcity":"BLACKSBURG                    ","mstate":"VA","mzip":"24060-2426","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K02.9","K08.89","E03.9","F32.9","Z79.84","Z79.890","F39","K04.7","R05","R00.0","N20.0","R19.7","E66.01","Z87.891","R10.9","N13.2","R11.0","N20.2","N20.1","M54.5","M54.6","R07.9","F33.0","G89.29","L60.0","M79.674","J01.80","H00.011","B37.9","M25.561","L02.811","L03.811","R73.01","E11.9","H00.014","E11.65","N89.8","E28.2","N91.2","N93.9","L02.91","R03.0","R32"],"date":["2019-01-27","2019-01-27","2021-03-10","2019-10-20","2020-08-24","2019-10-20","2019-04-09","2019-01-27","2019-04-09","2019-04-09","2019-08-13","2019-08-13","2019-08-13","2020-03-24","2019-08-18","2019-08-18","2019-08-18","2019-08-27","2019-08-18","2020-05-18","2019-10-20","2019-10-20","2020-01-29","2020-05-18","2020-03-18","2020-03-18","2020-03-24","2020-04-13","2021-03-10","2020-04-23","2020-05-18","2020-05-18","2020-05-18","2020-06-02","2020-08-24","2021-03-10","2020-11-10","2020-11-10","2020-12-14","2020-12-18","2021-02-12","2021-03-10","2021-04-23"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","00254202980","PREVIFEM","","28","Select","Select",""],["","00555077902","MEDROXYPR","10MG","90","Select","Select",""],["","50419042301","MIRENA","SYSTEM","1","Select","Select",""],["","42571016242","AMOX\/K","875-125","20","Select","Select",""],["","69315030805","CIPROFLOXACN","0.3% OP","5","Select","Select",""],["","00904685272","LORATADINE","10MG","7","Select","Select",""],["","00234057504","HIBICLENS","4%","472","Select","Select",""],["","43547040011","CYCLOBENZAPR","10MG","15","Select","Select",""],["","42806031205","DOXYCYCL","100MG","20","Select","Select",""],["","45802005535","TRIAMCINOLON","0.10%","15","Select","Select",""],["","67405060403","FLUCONAZOLE","200MG","7","Select","Select",""],["","29300022701","METRONIDAZOL","500MG","14","Select","Select",""],["","69543013611","TRAMADOL","50MG","10","Select","Select",""],["","00378180910","LEVOTHYROXIN","100MCG","30","Select","Select",""],["","65862001305","SERTRALINE","100MG","30","Select","Select",""],["","63868091628","BACITRACIN","500\/GM","28.4","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","67877057505","BENZONATATE","200MG","30","Select","Select",""],["","65862064163","AZITHROMYCIN","250MG","6","Select","Select",""],["","00597015330","JARDIANCE","25MG","30","Select","Select",""],["","60758090810","POLYMYXIN","TRIMETHP","10","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","30","Select","Select",""],["","57237023305","SMZ-TMP","800-160","20","Select","Select",""],["","00378113401","KETOROLAC","10MG","15","Select","Select",""],["","23155050105","HYDROXYZ","25MG","30","Select","Select",""],["","59746017310","PREDNISONE","10MG","15","Select","Select",""],["","69367018205","METFORMIN","1000MG","60","Select","Select",""],["","67877032005","IBUPROFEN","600MG","90","Select","Select",""],["","00193731221","CONTOUR","NEXT","100","Select","Select",""],["","00193658621","MICROLET","LANCETS","100","Select","Select",""],["","51672130200","TERCONAZOLE","0.80%","20","Select","Select",""],["","00254202980","PREVIFEM ","TAB ","28","Select","Select",""],["","00555077902","MEDROXYPR ","TAB 10MG","90","Select","Select",""],["","50419042301","MIRENA ","IUD SYSTEM","1","Select","Select",""],["","42571016242","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","69315030805","CIPROFLOXACN ","SOL 0.3% OP","5","Select","Select",""],["","00904685272","LORATADINE ","TAB 10MG","7","Select","Select",""],["","00234057504","HIBICLENS ","LIQ 0.04","472","Select","Select",""],["","43547040011","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","42806031205","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","45802005535","TRIAMCINOLON ","OIN 0.001","15","Select","Select",""],["","67405060403","FLUCONAZOLE ","TAB 200MG","7","Select","Select",""],["","29300022701","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","69543013611","TRAMADOL ","TAB 50MG","10","Select","Select",""],["","00378180910","LEVOTHYROXIN ","TAB 100MCG","30","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","63868091628","BACITRACIN ","OIN 500\/GM","28.4","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","67877057505","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","65862064163","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00597015330","JARDIANCE ","TAB 25MG","30","Select","Select",""],["","60758090810","POLYMYXIN ","SOL TRIMETHP","10","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","57237023305","SMZ-TMP ","TAB 800-160","20","Select","Select",""],["","00378113401","KETOROLAC ","TAB 10MG","15","Select","Select",""],["","23155050105","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","59746017310","PREDNISONE ","TAB 10MG","15","Select","Select",""],["","69367018205","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","90","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","00193658621","MICROLET ","MIS LANCETS","100","Select","Select",""],["","51672130200","TERCONAZOLE ","CRE 0.008","20","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","",""],["No","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":""}]}]}