{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANASTASIA   C ACCETTULLI","gend":1,"add":"120 WEST MARSHALL ST APT 3","city":"WYTHEVILLE","state":"VA","zip":"24382-9998","dob":"1966-12-14","age":"","mstatus":"","insh":"900039770*01","cliId":"1UR2HX3VA01","pno":"276\/620-0919","cno":"276\/620-0919","email":"","ename":"","eno":"","pphy":"THOMAS, KARI L DO","ppno":"276\/228-8686","pcpadd":"1375 WEST RIDGE RD","pcpcity":"WYTHEVILLE","pcpstate":"VA","pcpzip":24382,"pcpcounty":"","pcpid":147705,"pcpname":"Carilion Family Medicine Wytheville","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/228-4052","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","M54.2","M79.10","E66.3","Z79.899","M79.18","M51.36","M54.06","S99.922A","S99.912A","M79.89","S89.91XA","F43.12","M47.816","M47.817","F43.0","R10.32","R30.0","R11.0","M54.16","R07.9","K76.0","K57.30","Z90.49","Z90.710","M46.1","Z79.891","N39.46","N32.81","R39.14","G89.4","S93.492A","S80.01XA","N39.41","E06.3","S20.211A","M62.838","S29.9XXA","R42.","F32.9","I10.","K58.9","F43.10","E89.0","Z96.651","Z88.6","Z88.1","Z88.5","Z88.8","B37.2","E78.5","R73.9","M79.7","E11.9","F33.1","Z12.31","E03.9","R53.82","M79.12","J02.9","N93.9","E07.9","D89.89","R68.2","D72.829","Z72.0","R10.30","N95.0","K64.4","L70.0","B37.3","R87.622","M25.50","R79.82","R39.15","R35.0","M48.08","R51.9","H53.9","H54.7","I67.89"],"date":["2021-08-24","2021-11-11","2021-09-30","2021-09-30","2021-10-14","2021-11-04","2021-11-11","2021-11-11","2020-08-15","2020-08-15","2020-08-15","2020-08-15","2021-10-15","2020-08-24","2020-08-24","2020-08-24","2021-03-09","2020-10-21","2021-03-09","2020-10-21","2021-03-09","2020-11-30","2020-11-30","2020-11-30","2021-07-01","2021-11-11","2021-07-01","2020-08-31","2021-05-03","2020-08-31","2021-10-18","2020-08-15","2020-08-15","2021-05-03","2021-07-01","2021-03-09","2021-11-11","2021-03-09","2021-03-09","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-03-09","2021-03-09","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2020-09-17","2020-09-17","2020-09-17","2021-09-30","2021-04-26","2021-10-12","2021-04-05","2021-04-05","2021-04-05","2021-06-04","2021-04-26","2021-07-06","2021-07-01","2021-07-01","2021-08-24","2021-07-16","2021-07-06","2021-07-01","2021-07-07","2021-07-07","2021-07-07","2021-07-27","2021-07-27","2021-08-24","2021-08-24","2021-08-23","2021-08-23","2021-08-24","2021-10-22","2021-10-22","2021-10-22","2021-10-22"],"priorHcc":[null,null,null,null,null,null,null,null,"","","","",null,"","","","","","","","","","","","",null,"","","","",null,"","","","","",null,"","","","","","","","","","","","","","","",null,"",null,"","","","","","","","",null,"","","","","","","","",null,null,null,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":[["","65862067899","ALPRAZOLAM","TAB 1MG","90","Select","Select",""],["","378182377","LEVOTHYROXIN","TAB 137MCG","90","Select","Select",""],["","42858010301","OXYCOD\/APAP","TAB 7.5-325","23","Select","Select",""],["","65862019405","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","60","Select","Select",""],["","69547035302","NARCAN","SPR ","-2","Select","Select",""],["","51672128901","NYSTATIN","CRE 100000","15","Select","Select",""],["","68382025605","OXYBUTYNIN","TAB 10MG ER","90","Select","Select",""],["","16729020001","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","49281042050","FLUZONE QUAD","INJ 2020-21","0","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","6","Select","Select",""],["","68462038730","SOLIFENACIN","TAB 10MG","90","Select","Select",""],["","57664047758","METOPROL TAR","TAB 50MG","180","Select","Select",""],["","5197102","PREVNAR 13","INJ ","0","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","180","Select","Select",""],["","50111045001","TRAZODONE","TAB 150MG","90","Select","Select",""],["","42858010301","OXYCODONE\/ACETAMINOPHEN","","23","Select","Select",""],["","378182377","LEVOTHYROXINE SODIUM ","","90","Select","Select",""],["","62175061743","PANTOPRAZOLE SODIUM","","90","Select","Select",""],["","49281042050","FLUZONE QUADRIVALENT 2020-2021","","0","Select","Select",""],["","57664047758","METOPROLOL TARTRATE","","180","Select","Select",""],["","65862007701","CIPROFLOXACIN HYDROCHLORIDE ","","6","Select","Select",""],["","68382025605","OXYBUTYNIN CHLORIDE ER","","90","Select","Select",""],["","50111064801","FLUOXETINE HCL","","90","Select","Select",""],["","68462038730","SOLIFENACIN SUCCINATE","","90","Select","Select",""],["","65862019405","FLUOXETINE HYDROCHLORIDE","","90","Select","Select",""],["","50111045001","TRAZODONE HYDROCHLORIDE","","90","Select","Select",""],["","51991074890","DULOXETINE HYDROCHLORIDE","","60","Select","Select",""],["","16729020001","BUSPIRONE HYDROCHLORIDE","","90","Select","Select",""],["","42806016005","HYDROXYZINE HYDROCHLORIDE ","","120","Select","Select",""],["","65862007701","CIPROFLOXACIN HYDROCHLORIDE","","6","Select","Select",""],["","00378182377","LEVOTHYROXINE SODIUM","","90","Select","Select",""],["","42806016005","HYDROXYZINE HYDROCHLORIDE","","120","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","49281042150","FLUZONE QUADRIVALENT 2021-2022","2021-22","0","Select","Select",""],["","42858010301","OXYCODONE\/ACETAMINOPHEN                                               ","TAB 7.5-325","30","Select","Select",""],["","50111064801","FLUOXETINE HCL                                                        ","CAP 20MG","90","Select","Select",""],["","65862019405","FLUOXETINE HYDROCHLORIDE                                              ","CAP 40MG","90","Select","Select",""],["","68382025605","OXYBUTYNIN CHLORIDE ER                                                ","TAB 10MG ER","30","Select","Select",""],["","65862067899","ALPRAZOLAM                                                            ","TAB 1MG","90","Select","Select",""],["","68462038730","SOLIFENACIN SUCCINATE                                                 ","TAB 10MG","30","Select","Select",""],["","00378182377","LEVOTHYROXINE SODIUM                                                  ","TAB 137MCG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE SODIUM                                                   ","TAB 40MG","90","Select","Select",""],["","57664047758","METOPROLOL TARTRATE                                                   ","TAB 50MG","180","Select","Select",""],["","65862007701","CIPROFLOXACIN HYDROCHLORIDE                                           ","TAB 500MG","6","Select","Select",""],["","49281042050","FLUZONE QUADRIVALENT 2020-2021                                        ","INJ 2020-21","0","Select","Select",""],["","51672128901","NYSTATIN                                                              ","CRE 100000","15","Select","Select",""],["","50111045001","TRAZODONE HYDROCHLORIDE                                               ","TAB 150MG","90","Select","Select",""],["","51991074890","DULOXETINE HYDROCHLORIDE                                              ","CAP 60MG","60","Select","Select",""],["","69547035302","NARCAN                                                                ","SPR ","2","Select","Select",""],["","00005197102","PREVNAR 13                                                            ","INJ ","0","Select","Select",""],["","65862085901","FAMOTIDINE                                                            ","TAB 20MG","180","Select","Select",""],["","16729020001","BUSPIRONE HYDROCHLORIDE                                               ","TAB 5MG","90","Select","Select",""],["","42806016005","HYDROXYZINE HYDROCHLORIDE                                             ","TAB 25MG","120","Select","Select",""],["","70710113908","FLUCONAZOLE                                                           ","TAB 150MG","1","Select","Select",""],["","49281042150","FLUZONE QUADRIVALENT 2021-2022                                        ","INJ 2021-22","0","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","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","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":""}]}]}