{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMBER   N MOLES","gend":1,"add":"7126 FLOYD PIKE","city":"DUGSPUR","state":"VA","zip":"24325-9998","dob":"2001-08-21","age":"","mstatus":"","insh":"1888322*01","cliId":"","pno":"276\/728-2375","cno":"276\/728-2375","email":"","ename":"","eno":"","pphy":"KNISELY, THOMAS DO","ppno":"276\/728-7731","pcpadd":"SUITE A 416 SOUTH MAIN ST","pcpcity":"HILLSVILLE","pcpstate":"VA","pcpzip":24343,"pcpcounty":"","pcpid":147705,"pcpname":"ED Carilion Tazewell Community Hospital","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R30.0","Z23.","N89.8","N76.0","L60.0","E10.9","H04.123","Q14.1","E10.649","B34.9","A63.0","B07.0","M79.672","N76.1","A56.02","M79.674","E11.9","E78.5","R12.","Z76.89","Z79.899","Z30.41","F41.1","R31.9","N92.6","Z86.19","E10.65","A74.9","Z11.3","J01.90","E11.649","Z20.822","U07.1","NO DATA","E86.0","N83.201","R79.89","R50.9","Z20.828","R00.0","R52.","R10.13"],"date":["2021-03-10","2020-12-03","2021-03-10","2021-03-30","2020-05-26","2021-05-24","2021-05-24","2021-05-24","2020-07-29","2020-11-30","2021-05-13","2021-04-27","2021-04-27","2021-04-15","2021-04-15","2020-05-12","2020-05-26","2021-04-13","2020-06-11","2020-06-11","2020-06-11","2020-06-11","2021-03-24","2021-03-10","2021-03-10","2021-03-10","2021-03-24","2021-03-24","2021-03-16","2021-07-30","2021-07-30","2021-09-14","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-09-17","2021-09-17","2021-09-17","2021-09-23"],"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":[]},{"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":[["","00002879959","HUMALOG ","100\/ML","30","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","30","Select","Select",""],["","65862086001","FAMOTIDINE ","40MG","30","Select","Select",""],["","00002803101","GLUCAGON ","1MG","2","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","21","Select","Select",""],["","24208083060","NEO\/POLY\/DEX ","0.1% OP","5","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","00378728590","LEVONOR\/ETHI ","ESTRADIO","91","Select","Select",""],["","53885024450","ONETOUCH ","ULTRA","150","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","2","Select","Select",""],["","55111015001","FLUOXETINE ","10MG","30","Select","Select",""],["","68180016106","AZITHROMYCIN ","500MG","2","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","08290320122","BD  PEN NEEDL","32GX4MM","200","Select","Select",""],["","70377002711","ATORVASTATIN ","10MG","30","Select","Select",""],["","00002822259","INSULIN ","100\/ML","30","Select","Select",""],["","42806015905","HYDROXYZ ","10MG","60","Select","Select",""],["","00378064010","PREDNISONE ","5MG","10","Select","Select",""],["","57599080300","FREESTY ","2 READER","1","Select","Select",""],["","45802036862","IMIQUIMOD ","5%","12","Select","Select",""],["","00024592505","ADMELOG ","100U\/ML","30","Select","Select",""],["","64380071307","BENZONATATE ","200MG","21","Select","Select",""],["","00002879959","HUMALOG","100\/ML","30","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","00169633910","NOVOLOG","FLEXPEN","30","Select","Select",""],["","63304069205","CLINDAMYCIN","150MG","21","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","00002803101","GLUCAGON","1MG","2","Select","Select",""],["","65862086001","FAMOTIDINE","40MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00378728590","LEVONOR\/ETHI","ESTRADIO","91","Select","Select",""],["","08290320122","BD PEN NEEDL","32GX4MM","200","Select","Select",""],["","53885024450","ONETOUCH","ULTRA","150","Select","Select",""],["","55111015001","FLUOXETINE","10MG","30","Select","Select",""],["","42806015905","HYDROXYZ","10MG","60","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","68180016106","AZITHROMYCIN","500MG","2","Select","Select",""],["","66733082259","INSULIN","100\/ML","30","Select","Select",""],["","57599080000","FREESTY","2 SENSOR","2","Select","Select",""],["","45802036862","IMIQUIMOD","5%","12","Select","Select",""],["","64380071307","BENZONATATE","200MG","21","Select","Select",""],["","00024592505","ADMELOG","100U\/ML","30","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","8","Select","Select",""],["","27808003503","HYDROCO\/APAP","5-325MG","6","Select","Select",""],["","24208083060","NEO\/POLY\/DEX","0.1% OP","5","Select","Select",""],["","70377002711","ATORVASTATIN","10MG","30","Select","Select",""],["","00378064010","PREDNISONE","5MG","10","Select","Select",""],["","00143980305","DOXYCYCL","100MG","20","Select","Select",""],["","27808003503","HYDROCO\/APAP ","TAB 5-325MG","6","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","8","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","20","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}