{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUSAN S WALLACE","gend":1,"add":"3125 SOMERSET ST SW","city":"ROANOKE","state":"VA","zip":"24014-9998","dob":"1954-03-15","age":"","mstatus":"","insh":"900038641*01","cliId":"","pno":"540\/389-3209","cno":"","email":"","ename":"","eno":"","pphy":"ARTHUR, CHRISTY MD","ppno":"540\/725-7800","pcpadd":"SUITE 2 3707 BRAMBLETON AVE SW","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24018,"pcpcounty":"","pcpid":"","pcpname":"Carilion Family Medicine Brambleton","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/989-6752","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.552","R26.81","E20.9","G40.109","M21.6X1","M25.551","Z79.899","M16.0","M51.36","M24.7","M40.56","Z20.828","I10.","K59.00","R41.0","R47.81","J44.9","R91.8","R03.0","R94.31","Z01.810","Z01.812","S92.322A","S92.332A","S92.342A","S92.352A","M19.072","M77.32","X58.XXXA","F31.73","F79.","J20.9","R05.","M54.9","Z23.","Z00.00","H91.90","Z85.3","Z99.89","Z97.4","Z87.730","F31.11","Z20.822","M16.12","M16.11","E78.00","E83.52","E55.9","Z04.3","R35.0","R73.9","H90.3","H61.23","Z96.642","S01.91XA","W01.0XXA","H26.491","D51.0","M54.5","R68.89","S09.90XA","S80.02XA","S01.21XA","W01.10XA","M79.672","Z01.818","Z12.11","W19.XXXD","H02.846","E21.3","H91.93","S01.111A","Z79.82","Y92.002","S01.81XA","U07.1","Z13.820","Z48.02","S80.01XA"],"date":["2021-06-29","2021-05-17","2021-04-28","2021-04-28","2021-11-09","2021-06-29","2021-04-28","2021-12-02","2021-06-29","2021-12-02","2021-06-29","2021-09-19","2021-11-27","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-11-24","2021-11-24","2021-11-24","2021-11-29","2021-11-29","2021-11-29","2021-11-30","2021-11-29","2021-11-29","2021-11-29","2021-06-01","2021-06-01","2020-12-03","2020-12-03","2020-12-14","2021-09-28","2021-11-09","2020-12-14","2020-12-14","2020-12-14","2020-12-14","2020-12-14","2021-11-16","2021-12-05","2021-12-10","2021-12-10","2021-05-13","2021-11-02","2021-11-02","2021-11-27","2021-09-28","2021-09-28","2021-11-15","2021-11-15","2021-12-10","2021-08-07","2021-08-07","2020-03-09","2020-10-26","2021-06-29","2021-11-02","2021-11-27","2021-11-27","2021-11-27","2021-11-27","2021-11-30","2021-12-05","2021-05-23","2021-11-29","2021-11-29","2021-04-27","2021-06-09","2021-08-07","2021-11-27","2021-08-07","2021-08-07","2021-09-14","2020-03-19","2021-08-12","2021-11-27"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","51991029305","OXCARBAZEPINE ","300MG","30","Select","Select",""],["","60505311408","OLANZAPINE ","15MG","30","Select","Select",""],["","00093738456","VENLAFAXINE HCL ER ","37.5 ER","30","Select","Select",""],["","00228207610","TEMAZEPAM ","15MG","30","Select","Select",""],["","68180047903","SIMVASTATIN ","20MG","30","Select","Select",""],["","00527134310","LEVOTHYROXINE SODIUM ","75MCG","15","Select","Select",""],["","53746018801","NAPROXEN ","250MG","30","Select","Select",""],["","00904421713","VITAMIN B-12 ","1000MCG","4","Select","Select",""],["","00245010810","FERROUS SULFATE ","325MG EC","15","Select","Select",""],["","49100036374","CULTURELLE IMMUNITY SUPPORT FORMULA ","IMMUNITY","30","Select","Select",""],["","64980030550","DENTA 5000 PLUS ","PLUS","51","Select","Select",""],["","00904188380","OYSTER SHELL CALCIUM ","500MG","29","Select","Select",""],["","00065143105","SYSTANE ULTRA ","","10","Select","Select",""],["","00135008969","CITRUCEL FIBER LAXATIVE ","ORANGE","479","Select","Select",""],["","40985022713","MAGNESIUM ","250MG","120","Select","Select",""],["","61442012110","FAMOTIDINE ","20MG","39","Select","Select",""],["","53489011905","DOXYCYCLINE HYCLATE ","100MG","20","Select","Select",""],["","67877057505","BENZONATATE ","200MG","30","Select","Select",""],["","00536444554","REGULOID ","28.30%","576","Select","Select",""],["","96295013818","DAILY FIBER ","","576","Select","Select",""],["","42192033801","HYOSCYAMINE SULFATE ODT ","0.125MG","30","Select","Select",""],["","00487950125","ALBUTEROL SULFATE ","0.08%","75","Select","Select",""],["","13668011390","LOSARTAN POTASSIUM ","25MG","7","Select","Select",""],["","00378342201","NITROFURANTOIN MONOHYDRATE ","100MG","20","Select","Select",""],["","41167000881","ICY HOT ORIGINAL PAIN RELIEF ","PAIN REL","85","Select","Select",""],["","10702005601","OXYCODONE HYDROCHLORIDE ","10MG","30","Select","Select",""],["","68180050201","MELOXICAM ","15MG","23","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","3","Select","Select",""],["","64380073706","VITAMIN D ","50000UNT","3","Select","Select",""],["","00126001661","PREVIDENT 5000 DRY MOUTH ","1.10%","100","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA ","HFA","8","Select","Select",""],["","00591079401","DICYCLOMINE HYDROCHLORIDE ","10MG","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}