{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LORENDA F GOODMAN","gend":1,"add":"727 MUSE FIELD ROAD","city":"ROCKY MOUNT","state":"VA","zip":24151,"dob":"1965-08-08","age":"","mstatus":"","insh":"900036018*01","cliId":"","pno":"540\/352-0077","cno":"540\/352-0077    ","email":"","ename":"","eno":"","pphy":"MAXEY, JAMES ALLEN DO","ppno":"540\/483-5168","pcpadd":"796 OLD FRANKLIN TURNPIKE","pcpcity":"ROCKY MOUNT","pcpstate":"VA","pcpzip":24151,"pcpcounty":"FRANKLIN","pcpid":147705,"pcpname":"Carilion Clinic Family Medicine Rocky Mount","plan":"OHP - OPTIMA","program":"MEDICARE","lob":"DSNP","region":"Roanoke","aligned":"N","ano":"540\/352-0077, ","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.9","D12.4","R10.9","K31.7","K21.9","D12.6","K58.1","Q43.8","G89.29","J45.50","G47.30","Z79.51","F17.210","E11.51","Z79.84","E66.01","Z68.42","I10.","F25.1","M25.551","Z12.11","M54.5","M79.7","M25.552","J20.8","L85.3","E11.9","E78.2","E06.3","R56.9","E55.9","Z00.00","J30.89","J06.9","R05.","R09.89","R06.2","R10.12","K59.04","Z72.0","M79.671","M79.672","R60.0","M79.89","R63.4","G60.3","E11.40","I73.9","R60.9","H25.13","Z86.69","J01.40","F17.200","J32.9","H92.03","L30.9","H61.20"],"date":["2021-01-04","2019-10-15","2020-05-06","2019-10-24","2020-03-09","2019-10-24","2019-10-15","2019-10-15","2020-03-09","2019-10-15","2019-10-15","2019-10-15","2019-10-15","2019-10-15","2019-10-15","2019-10-15","2019-10-15","2021-02-09","2020-12-22","2020-07-23","2019-11-14","2019-12-19","2019-12-19","2019-12-19","2020-01-14","2020-01-14","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2020-02-11","2020-02-11","2021-01-28","2020-02-25","2020-02-25","2020-02-25","2020-05-06","2020-03-09","2020-03-09","2020-08-24","2020-08-24","2020-04-22","2020-05-05","2020-05-06","2020-09-02","2020-06-01","2020-06-01","2020-06-01","2020-08-07","2020-09-08","2020-10-14","2020-10-14","2020-11-19","2021-03-23","2021-03-23","2021-03-09"],"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[["","69238183607","LEVOTHYROXIN TAB ","125MCG","30","Select","Select",""],["","65862000899","METFORMIN TAB ","500MG","90","Select","Select",""],["","781185220","AMOX\/K CLAV ","TAB 875-125","20","Select","Select",""],["","68180045001","QUETIAPINE TAB ","400MG","60","Select","Select",""],["","13107000334","MIRTAZAPINE TAB ","30MG","30","Select","Select",""],["","69097083512","SERTRALINE TAB ","100MG","30","Select","Select",""],["","42571012290","LEVOCETIRIZI TAB ","5MG","90","Select","Select",""],["","65862055990","PANTOPRAZOLE TAB ","20MG","60","Select","Select",""],["","527058610","DICYCLOMINE CAP ","10MG","360","Select","Select",""],["","65862085901","FAMOTIDINE TAB ","20MG","90","Select","Select",""],["","65862042005","SMZ\/TMP DS ","TAB 800-160","20","Select","Select",""],["","42806066405","BUSPIRONE TAB ","15MG","90","Select","Select",""],["","832712411","DIVALPROEX TAB ","500MG DR","120","Select","Select",""],["","65862052305","GABAPENTIN TAB ","600MG","90","Select","Select",""],["","69452015120","VITAMIN D ","CAP 50000UNT","12","Select","Select",""],["","70377002913","ATORVASTATIN TAB ","40MG","90","Select","Select",""],["","65862017760","CEFDINIR  ","CAP 300MG","20","Select","Select",""],["","603533815","PREDNISONE PAK ","10MG","21","Select","Select",""],["","65862069201","PHENYTOIN EX ","CAP 100MG","360","Select","Select",""],["","70436001006","BUPROPN HCL ","TAB 150MG XL","30","Select","Select",""],["","472037915","CLOTRIM\/BETA CRE ","DIPROP","15","Select","Select",""],["","93406801","PRAZOSIN HCL ","CAP 2MG","30","Select","Select",""],["","69097094312","GABAPENTIN CAP ","300MG","30","Select","Select",""],["","186037020","SYMBICORT AER ","160-4.5","10","Select","Select",""],["","173068220","VENTOLIN HFA ","AER","18","Select","Select",""],["","65702040810","ACCU-CHEK TES ","AVIVA PL","100","Select","Select",""],["","832046515","NYAMYC  ","POW 100000","15","Select","Select",""],["","135023004","NICORETTE GUM ","4MG MINT","110","Select","Select",""],["","536311301","NICOTINE POL ","GUM 4MG MINT","100","Select","Select",""],["","51991070505","ALPRAZOLAM TAB ","0.5MG","-120","Select","Select",""],["","68180098003","LISINOPRIL TAB ","10MG","90","Select","Select",""],["","55111029209","SUMATRIPTAN TAB ","50MG","9","Select","Select",""],["","24208063562","NEO\/POLY\/HC SUS ","1% OTIC","10","Select","Select",""],["","527169501","BUT\/APAP\/CAF TAB","","30","Select","Select",""],["","536199553","ANTI-DANDRUF SHA ","1%","207","Select","Select",""],["","51672201802","HYDROCORT OIN ","1%","28","Select","Select",""],["","60432060416","PROMETHAZINE SYP ","DM","120","Select","Select",""],["","29300012510","MELOXICAM TAB ","15MG","30","Select","Select",""],["","33342002208","LEVOFLOXACIN TAB ","500MG","10","Select","Select",""],["","527293341","PREDNISONE TAB ","10MG","15","Select","Select",""],["","65862064163","AZITHROMYCIN TAB ","250MG","6","Select","Select",""],["","57896048930","POLYETH GLYC ","POW 3350 NF","527","Select","Select",""],["","69315011610","FUROSEMIDE TAB ","20MG","30","Select","Select",""],["","69097052444","DICLOFENAC GEL ","1%","100","Select","Select",""],["","310737020","BUDES\/FORMOT AER ","160-4.5","10","Select","Select",""],["","66993001968","ALBUTEROL AER ","HFA","18","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","30","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","20","Select","Select",""],["","70436001006","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","13107000334","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","70377002913","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","65862000899","METFORMIN","TAB 500MG","90","Select","Select",""],["","832712411","DIVALPROEX","TAB 500MG DR","120","Select","Select",""],["","45802000910","FLUOCIN ACET","OIL 0.0001","20","Select","Select",""],["","69238183607","LEVOTHYROXIN","TAB 125MCG","30","Select","Select",""],["","93406801","PRAZOSIN HCL","CAP 2MG","30","Select","Select",""],["","65862055990","PANTOPRAZOLE","TAB 20MG","60","Select","Select",""],["","603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","62332000131","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","90","Select","Select",""],["","67877024801","QUETIAPINE","TAB 400MG","60","Select","Select",""],["","65862069201","PHENYTOIN EX","CAP 100MG","360","Select","Select",""],["","69238111806","BUSPIRONE","TAB 15MG","90","Select","Select",""],["","527058610","DICYCLOMINE","CAP 10MG","360","Select","Select",""],["","42571012290","LEVOCETIRIZI","TAB 5MG","90","Select","Select",""],["","168002031","HYDROCORT","OIN 0.01","28","Select","Select",""],["","65702040810","ACCU-CHEK","TES AVIVA PL","100","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","12","Select","Select",""],["","55111029298","SUMATRIPTAN","TAB 50MG","-9","Select","Select",""],["","536311301","NICOTINE POL","GUM 4MG MINT","100","Select","Select",""],["","51991070505","ALPRAZOLAM","TAB 0.5MG","120","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","33342002208","LEVOFLOXACIN","TAB 500MG","10","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","120","Select","Select",""],["","65862064130","AZITHROMYCIN","TAB 250MG","-6","Select","Select",""],["","186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","472037915","CLOTRIM\/BETA","CRE DIPROP","-15","Select","Select",""],["","832046560","NYAMYC","POW 100000","60","Select","Select",""],["","135023004","NICORETTE","GUM 4MG MINT","110","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","-20","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","781185220","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","527169501","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","24208063562","NEO\/POLY\/HC","SUS 1% OTIC","10","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","536199553","ANTI-DANDRUF","SHA 0.01","207","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","57896048930","POLYETH GLYC","POW 3350 NF","527","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}