{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RANDY   C CARR","gend":0,"add":"420 THOMPSON ST","city":"DAYTON","state":"VA","zip":"22821-9998","dob":"1965-05-07","age":"","mstatus":"","insh":"900043624*01","cliId":"9W56VK5KR66","pno":"540\/810-1234","cno":"540\/810-1234","email":"","ename":"","eno":"","pphy":"PENCE, ROBERT P MD","ppno":"540\/879-4300","pcpadd":"HWY 42 S 15 KILLDEER LANE","pcpcity":"DAYTON","pcpstate":"VA","pcpzip":22821,"pcpcounty":"","pcpid":117706,"pcpname":"Carilion Family Medicine - Dayton","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/879-9627","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.572","S96.902D","L97.512","M67.01","S82.65XD","S92.231P","S92.321P","E11.40","M12.571","G62.9","S82.65XK","I10.","R73.01","Z86.711","E78.9","D50.8","M79.18","K50.919","E55.9","E83.42","G47.00","Z12.5","M86.671","Z01.810","J98.4","Z45.2","M86.10","H61.21","L97.419","M19.071","E11.621","L97.519","M86.679","K50.012","K43.9","K21.9","K56.51","L57.0","S82.62XD","S93.492A","S93.422A","M72.2","Z08.","Z85.828","L97.516","L97.326","M86.171","L97.511","Z89.421","M86.9","M14.671","M21.961","R93.89","K50.90","Z79.2","G60.9","D84.9","B35.4","B35.1","D48.5","D50.0","G89.18","K68.11","L02.211","K43.5","Z93.2","S86.312A","M86.8X9","M86.371","I48.0","R06.09","G47.33","K50.912","Z79.52","I96.","M79.644","S62.646A","S01.01XD","Z48.02","L84.","M79.671","Z12.11","Z79.899","D53.9","S82.832A","M24.072","S01.01XA","S09.90XA","S29.8XXA","S39.91XA","K50.112","I82.4Z1","G89.4","E43.","C44.92","R73.09","L08.9","L03.116","Z23.","L97.521","R21.","D04.62","D04.71","I87.2","B07.8","L82.1","L40.9","Z51.81","S39.011A","R78.81","K50.818","Z09.","B07.9","B99.9","M79.89","R60.0"],"date":["2021-07-27","2021-07-27","2021-08-04","2021-07-27","2021-01-05","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-10-07","2021-01-11","2021-01-11","2021-10-07","2021-04-21","2021-01-11","2021-07-13","2021-01-11","2021-01-11","2021-10-07","2021-01-11","2021-02-08","2021-04-09","2021-04-13","2021-04-13","2021-04-21","2021-05-05","2021-11-08","2021-11-08","2021-11-10","2021-10-25","2021-04-01","2021-10-18","2021-04-21","2021-10-07","2021-04-21","2021-05-25","2021-05-05","2021-05-05","2021-05-05","2021-05-05","2021-05-25","2021-09-07","2021-01-29","2021-01-29","2021-08-04","2021-11-08","2021-11-08","2021-04-27","2021-11-08","2021-11-08","2021-08-16","2021-01-13","2021-01-13","2021-02-12","2021-04-01","2021-04-30","2021-04-30","2021-04-30","2021-01-29","2021-02-08","2021-03-10","2021-03-10","2021-03-10","2021-11-18","2021-05-05","2021-03-30","2021-04-27","2021-11-18","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-02-08","2021-06-09","2021-06-09","2021-06-18","2021-06-18","2021-11-08","2021-07-27","2021-05-23","2021-06-14","2021-08-18","2021-07-09","2021-07-09","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-07-13","2021-07-13","2021-11-08","2021-11-18","2021-10-07","2021-11-08","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-10-06","2021-10-06","2021-03-10","2021-11-18","2021-11-18","2021-11-18","2021-09-07","2021-11-08","2021-11-08","2021-11-08"],"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,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":[["","00338004904","SOD ","0.90%","280","Select","Select",""],["","29300013201","ZALEPLON ","10MG","-120","Select","Select",""],["","70377000812","ROSUVASTATIN ","20MG","-30","Select","Select",""],["","57664050318","TIZANIDINE ","4MG","60","Select","Select",""],["","60505615005","CEFTRIAXONE ","10GM","2","Select","Select",""],["","31722095105","OXYCOD\/APAP ","10-325MG","150","Select","Select",""],["","00054474131","PREDNISONE ","1MG","360","Select","Select",""],["","67877012405","SILVER ","1%","50","Select","Select",""],["","08290306546","NORMAL ","0.90%","180","Select","Select",""],["","00378001805","METOPROL ","25MG","90","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120","Select","Select",""],["","00781185220","AMOX\/K ","875-125","28","Select","Select",""],["","31722071310","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","00703012501","DAPTOMYCIN ","500MG","9","Select","Select",""],["","60505619604","ERTAPENEM ","1GM","-7","Select","Select",""],["","68180065208","DOXYCYC ","100MG","28","Select","Select",""],["","45802006405","TRIAMCINOLON ","0.10%","454","Select","Select",""],["","69097073107","TERBINAFINE ","250MG","28","Select","Select",""],["","13668033201","TRAZODONE ","150MG","90","Select","Select",""],["","45802036862","IMIQUIMOD ","5%","24","Select","Select",""],["","00378702393","ACITRETIN ","25MG","30","Select","Select",""],["","65862020199","LOSARTAN ","25MG","90","Select","Select",""],["","60505615005","","10GM","2","Select","Select",""],["","08290306546","NORMAL","0.90%","180","Select","Select",""],["","70377000812","ROSUVASTATIN","20MG","-30","Select","Select",""],["","00054472831","PREDNISONE","5MG","60","Select","Select",""],["","00093321992","KETOCONAZOLE","2%","60","Select","Select",""],["","00338004904","SOD","0.90%","240","Select","Select",""],["","31722095105","OXYCOD\/APAP","10-325MG","150","Select","Select",""],["","29300013201","ZALEPLON","10MG","-120","Select","Select",""],["","57664050318","TIZANIDINE","4MG","60","Select","Select",""],["","60505615005","CEFTRIAXONE","10GM","1","Select","Select",""],["","31722071310","PANTOPRAZOLE","40MG","90","Select","Select",""],["","67877012405","SILVER","1%","50","Select","Select",""],["","00703012501","DAPTOMYCIN","500MG","-10","Select","Select",""],["","60505619600","ERTAPENEM","1GM","7","Select","Select",""],["","13668033201","TRAZODONE","150MG","90","Select","Select",""],["","00378001805","METOPROL","25MG","90","Select","Select",""],["","68180065208","DOXYCYC","100MG","28","Select","Select",""],["","68682027275","IMIQUIMOD","3.75%PMP","8","Select","Select",""],["","45802006405","TRIAMCINOLON","0.10%","454","Select","Select",""],["","69097073107","TERBINAFINE","250MG","28","Select","Select",""],["","00378702393","ACITRETIN","25MG","30","Select","Select",""],["","00781185220","AMOX\/K","875-125","28","Select","Select",""],["","21922001707","CLOBETASOL","0.05%","60","Select","Select",""],["","57237009650","CEFADROXIL","500MG","28","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","57894006003","STELARA","45MG\/0.5","1","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","34","Select","Select",""],["","65862020199","LOSARTAN","25MG","90","Select","Select",""],["","59651036105","IBUPROFEN","600MG","24","Select","Select",""],["","59762371809","TRIAZOLAM","0.25MG","3","Select","Select",""],["","58657015101","FOLIC","1MG","90","Select","Select",""],["","21922001707","CLOBETASOL ","OIN 0.0005","60","Select","Select",""],["","31722052001","HYDRALAZINE ","TAB 25MG","60","Select","Select",""],["","57237009650","CEFADROXIL ","CAP 500MG","28","Select","Select",""],["","58657015101","FOLIC ","TAB 1MG","90","Select","Select",""],["","57894006003","STELARA ","INJ 45MG\/0.5","-1","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","59651036105","IBUPROFEN ","TAB 600MG","24","Select","Select",""],["","59762371809","TRIAZOLAM ","TAB 0.25MG","3","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","34","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","14","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":""}]}]}