{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATSY RAMIREZ","gend":1,"add":"1500 STAPLES ST LOT 19","city":"RADFORD","state":"VA","zip":"24141-9998","dob":"1977-10-23","age":"","mstatus":"","insh":"900044525*01","cliId":"","pno":"806\/437-5340","cno":"","email":"","ename":"","eno":"","pphy":"KADIRI, MOHAMED MD","ppno":"540\/381-6000","pcpadd":"205 ROANOKE ST","pcpcity":"CHRISTIANSBURG","pcpstate":"VA","pcpzip":24073,"pcpcounty":"","pcpid":"","pcpname":"Carilion Clinic Family Medicine Christiansburg","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/381-2989","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.42","M54.12","M51.36","E66.01","I10.","F41.1","Z12.31","M54.41","G89.29","R94.31","M47.816","Z72.0","Z79.899","G89.4","H16.291","M54.2","E78.2","R00.2","R06.00","E88.81","F17.200","M79.89","E55.9","H52.13","H52.223","H52.4","Z00.00","Z23.","M25.571","M43.16","M54.5","J01.90","K59.01","Z20.822","Z20.828","I07.1","R07.9","R06.02","L65.9","H10.32","F29.","F32.9","F41.9","F39.","F41.0","R00.0"],"date":["2021-05-11","2021-05-11","2021-05-11","2021-11-30","2021-11-30","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-20","2021-11-29","2021-11-29","2021-11-29","2021-11-29","2021-06-10","2021-05-17","2021-05-19","2021-05-20","2021-05-19","2021-05-19","2021-11-30","2021-05-19","2021-05-19","2021-06-10","2021-06-10","2021-06-10","2021-11-30","2021-11-30","2021-02-12","2021-06-07","2021-06-07","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-05-20","2021-05-20","2021-05-20","2021-11-30","2021-04-27","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-06-01"],"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":[["","16571020106","DICLOFENAC SODIUM DR                                                  ","75MG DR","30","Select","Select",""],["","14539067401","HYDROXYZINE PAMOATE                                                   ","25MG","90","Select","Select",""],["","51991074890","DULOXETINE HYDROCHLORIDE                                              ","60MG","90","Select","Select",""],["","68180052001","LISINOPRIL\/HYDROCHLOROTHIAZIDE                                        ","20-25MG","90","Select","Select",""],["","61269046090","XENICAL                                                               ","120MG","90","Select","Select",""],["","43547034306","RISPERIDONE                                                           ","3MG","-60","Select","Select",""],["","65862050320","AMOXICILLIN\/CLAVULANATE POTASSIUM                                     ","875-125","14","Select","Select",""],["","69584061150","METHOCARBAMOL                                                         ","500MG","-180","Select","Select",""],["","69097081507","GABAPENTIN                                                            ","400MG","270","Select","Select",""],["","50111056101","TRAZODONE HYDROCHLORIDE                                               ","100MG","180","Select","Select",""],["","64764017130","DEXILANT                                                              ","30MG DR","90","Select","Select",""],["","24208083060","NEOMYCIN\/POLYMYXIN\/DEXAMETHASONE                                      ","0.1% OP","5","Select","Select",""],["","59267100002","PFIZER-BIONTECH COVID-19 VACCINE                                      ","COVID-19","0","Select","Select",""],["","00603020922","MAGNESIUM OXIDE                                                       ","400MG","180","Select","Select",""],["","61314064305","TOBRAMYCIN SULFATE                                                    ","0.3% OP","5","Select","Select",""],["","65162019050","NAPROXEN                                                              ","500MG","60","Select","Select",""],["","53746010901","HYDROCODONE\/ACETAMINOPHEN                                             ","5-325MG","60","Select","Select",""],["","53746010901","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","5-325MG","90","Select","Select",""],["","69097052444","DICLOFENAC SODIUM                                                     ","1%","200","Select","Select",""],["","00054001925","PREDNISONE                                                            ","50MG","5","Select","Select",""],["","45802048678","DOCUSATE SODIUM                                                       ","100MG","30","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE                                                ","50MCG","16","Select","Select",""],["","16729020301","BUSPIRONE HCL                                                         ","15MG","90","Select","Select",""],["","68180016011","AZITHROMYCIN                                                          ","250MG","6","Select","Select",""],["","20555000500","CALCIUM                                                               ","600MG","90","Select","Select",""],["","68382003416","VENLAFAXINE HCL ER                                                    ","37.5 ER","90","Select","Select",""],["","50428054266","CVS VITAMIN D3                                                        ","10000UNT","90","Select","Select",""],["","68382003516","VENLAFAXINE HYDROCHLORIDE ER                                          ","75MG ER","30","Select","Select",""],["","65162052110","PROMETHAZINE HYDROCHLORIDE                                            ","25MG","12","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":["",""]}},{"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":""}]}]}