{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GARY   W COOPER","gend":0,"add":"1035 SCUFFLING HILL ROAD","city":"ROCKY MOUNT","state":"VA","zip":"24151-9998","dob":"1958-12-21","age":"","mstatus":"","insh":"20025768*01","cliId":"","pno":"540\/263-2744","cno":"540\/263-2744","email":"","ename":"","eno":"","pphy":"HAYES, BRITTANY B DO","ppno":"540\/484-4800","pcpadd":"390 SOUTH MAIN ST SUITE 201","pcpcity":"ROCKY MOUNT","pcpstate":"VA","pcpzip":24151,"pcpcounty":"","pcpid":147720,"pcpname":"Carilion Medical Associates Rocky Mount","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/484-4862","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I25.119","F32.1","I25.5","F17.210","E78.1","Z79.01","M25.551","Z45.02","Z95.810","R29.898","I95.9","Z96.641","F17.200","I51.3","I47.1","R94.31","G57.21","E87.1","R79.1","R20.2","R53.1","R20.0","R69.","G57.91","I50.42","D68.4","I25.10","I08.0","R93.1","R29.6","M79.89","I50.23","Z86.718","Z86.73","D64.9","E78.5","G57.11","I11.0","F32.9","E78.00","F17.290","S81.801A","R26.89","R26.81","M62.81","M79.651","G57.20","Z47.1","M25.451","I70.25","Z68.20","S90.31XA","Z51.81","I50.22","F17.211","I10.","L97.511","T84.010A","D21.5"],"date":["2021-04-29","2021-04-29","2021-09-03","2020-10-29","2021-04-29","2021-09-03","2021-09-02","2021-05-12","2021-09-03","2021-07-26","2021-07-30","2021-09-02","2020-04-29","2020-04-29","2020-12-28","2021-07-22","2021-09-02","2021-07-26","2021-07-23","2021-07-22","2021-07-23","2021-09-14","2021-07-30","2021-07-26","2021-07-26","2021-07-26","2021-09-03","2021-07-23","2021-07-23","2021-09-14","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-30","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-02","2021-08-24","2021-08-30","2021-08-30","2021-08-17","2021-09-03","2021-09-03","2021-09-03","2021-09-10","2021-09-10","2021-11-05","2021-11-05"],"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":[["","76385011050","CARVEDILOL ","3.125MG","60","Select","Select",""],["","00069046956","CHANTIX ","1MG","60","Select","Select",""],["","10370010150","BUPROPN ","150MG XL","30","Select","Select",""],["","68180051303","LISINOPRIL ","5MG","30","Select","Select",""],["","00093171601","WARFARIN ","4MG","90","Select","Select",""],["","70377003012","ATORVASTATIN ","80MG","30","Select","Select",""],["","68180036109","FENOFIBRATE ","145MG","30","Select","Select",""],["","10702001801","OXYCODONE ","5MG","20","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","69097052444","DICLOFENAC ","1%","300","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","20","Select","Select",""],["","71093014005","METHOCARBAM ","500MG","120","Select","Select",""],["","69097081312","GABAPENTIN ","100MG","90","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","30","Select","Select",""],["","10370010150","BUPROPN","150MG XL","30","Select","Select",""],["","76385011050","CARVEDILOL","3.125MG","60","Select","Select",""],["","68180036109","FENOFIBRATE","145MG","30","Select","Select",""],["","68180051303","LISINOPRIL","5MG","30","Select","Select",""],["","00093171601","WARFARIN","4MG","90","Select","Select",""],["","00069046956","CHANTIX","1MG","60","Select","Select",""],["","70377003012","ATORVASTATIN","80MG","30","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","71093014005","METHOCARBAM","500MG","120","Select","Select",""],["","69097052444","DICLOFENAC","1%","300","Select","Select",""],["","69097081312","GABAPENTIN","100MG","90","Select","Select",""],["","10702001801","OXYCODONE","5MG","10","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","30","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","70710175906","ENOXAPARIN ","INJ 60\/0.6ML","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}