{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHELBY HOLLAND","gend":1,"add":"93   MARROWBONE  CIRCLE                                     ","city":"RIDGEWAY                      ","state":"VA","zip":"24148-3341","dob":"1970-06-06","age":"","mstatus":"","insh":10056339,"cliId":"","pno":2763408603,"cno":2763408603,"email":"","ename":"","eno":"","pphy":"TWANA, FARAJ                                                ","ppno":"","pcpadd":"1107 Brookdale St # A","pcpcity":"Martinsville                  ","pcpstate":"VA","pcpzip":241124501,"pcpcounty":"","pcpid":"P0117819","pcpname":"CARILION MEDICAL ASSOCIATES MARTINSVILLE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"93   MARROWBONE  CIRCLE                                     ","madd2":"                                                            ","madd3":"","mcity":"RIDGEWAY                      ","mstate":"VA","mzip":"24148-3341","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.32","K80.00","K80.20","K80.62","M54.5","Z79.899","Z79.3","R11.2","R10.84","R93.3","K80.10","K82.1","F31.9","E66.9","Z79.1","Z88.0","K80.60","K81.9","J20.9","J01.90","J02.9","Z68.36","Z68.34","F31.81","F41.8","J30.2","F60.9","K21.9","Z51.81","Z13.220","Z71.3","Z71.89","Z13.29","Z12.31","F31.4","E66.1","Z68.33","F41.1","Z01.411","E66.2","Z68.35","E78.2","H11.432","Z76.89","Z13.0","R10.9","Z23","F41.9","N20.1","I10","R31.9","N13.2","H66.003","R05","R06.00","Z20.822","R07.0","R09.02","R06.02","R07.9","H66.92","F31.62","F90.0"],"date":["2021-09-21","2019-01-28","2019-01-20","2019-01-20","2019-01-20","2019-01-28","2019-01-20","2019-01-21","2019-01-21","2019-01-21","2019-01-28","2019-01-28","2019-01-28","2021-07-06","2019-01-28","2019-01-28","2019-01-29","2019-01-29","2021-06-02","2021-06-02","2021-06-01","2021-07-06","2019-08-05","2020-08-13","2020-06-30","2020-06-30","2019-08-16","2020-06-30","2019-08-16","2020-12-08","2020-08-13","2020-08-13","2020-12-08","2020-12-29","2020-03-02","2019-10-14","2019-10-14","2021-11-08","2020-02-04","2020-02-18","2020-02-18","2020-02-18","2020-07-09","2020-12-08","2020-12-08","2021-05-15","2020-12-08","2020-12-08","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-30","2021-06-01","2021-06-01","2021-06-01","2021-05-31","2021-06-01","2021-05-31","2021-05-31","2021-06-01","2021-11-08","2021-11-08"],"priorHcc":[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":[["","00054001925","PREDNISONE","50MG","6","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","65862022960","LAMOTRIGINE","150MG","60","Select","Select",""],["","13668000905","CITALOPRAM","10MG","30","Select","Select",""],["","00555902658","JUNEL","Jan-20","28","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","00093221001","SUCRALFATE","1GM","120","Select","Select",""],["","23155022801","ACYCLOVIR","800MG","30","Select","Select",""],["","70436006001","BUPROPION","200MG SR","60","Select","Select",""],["","16729020001","BUSPIRONE","5MG","60","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","30","Select","Select",""],["","24208029505","TOBRA\/DEXAME","0.3-0.1%","5","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","70377000612","ROSUVASTATIN","5MG","30","Select","Select",""],["","00573262065","ALAVERT","10MG","30","Select","Select",""],["","68382075810","METFORMIN","500MG","60","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","70377002711","ATORVASTATIN","10MG","30","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","41100080247","CLARITIN","10MG","30","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","43386035701","HYDROCO\/APAP","7.5-325","10","Select","Select",""],["","57237001401","TAMSULOSIN","0.4MG","12","Select","Select",""],["","00054001925","PREDNISONE ","TAB 50MG","6","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","16729020001","BUSPIRONE ","TAB 5MG","60","Select","Select",""],["","13668000905","CITALOPRAM ","TAB 10MG","30","Select","Select",""],["","68180060607","CLONIDINE ","TAB 0.1MG ER","30","Select","Select",""],["","65862023060","LAMOTRIGINE ","TAB 200MG","30","Select","Select",""],["","70436006001","BUPROPION ","TAB 200MG SR","60","Select","Select",""],["","00555902658","JUNEL ","TAB 43831","28","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","00093221001","SUCRALFATE ","TAB 1GM","120","Select","Select",""],["","23155022801","ACYCLOVIR ","TAB 800MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","24208029505","TOBRA\/DEXAME ","SUS 0.3-0.1%","5","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","30","Select","Select",""],["","70377000612","ROSUVASTATIN ","TAB 5MG","30","Select","Select",""],["","00573262065","ALAVERT ","TAB 10MG","30","Select","Select",""],["","68382075810","METFORMIN ","TAB 500MG","60","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","70377002711","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","41100080247","CLARITIN ","TAB 10MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","12","Select","Select",""],["","43386035701","HYDROCO\/APAP ","TAB 7.5-325","10","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","12","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0.25","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}