{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELBA   D SPARKS","gend":1,"add":"458 EAGLE ROAD PO BOX 274","city":"ROCKY GAP","state":"VA","zip":"24366-9998","dob":"1957-02-10","age":"","mstatus":"","insh":"20035406*01","cliId":"","pno":"276\/928-8113","cno":"276\/928-8113","email":"","ename":"","eno":"","pphy":"THOMAS, KARI L DO","ppno":"276\/228-8686","pcpadd":"1375 WEST RIDGE RD","pcpcity":"WYTHEVILLE","pcpstate":"VA","pcpzip":24382,"pcpcounty":"","pcpid":147705,"pcpname":"Carilion Family Medicine Wytheville","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/228-4052","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.16","Z79.899","M54.31","L40.9","E66.9","Z68.38","L40.0","I10.","Z71.3","R73.03","G89.4","M54.9","F32.9","F41.9","Z12.39","E11.9","NO DATA","M54.5","M79.604","M79.605","R19.03","N39.3","B37.9","M96.1","G89.29","Z79.891","H04.123","H35.033"],"date":["2021-03-02","2020-08-05","2020-08-05","2021-01-04","2021-01-14","2021-01-14","2021-01-12","2021-05-05","2021-01-14","2021-01-14","2020-11-30","2020-11-30","2021-05-05","2021-05-05","2020-01-03","2021-05-05","2021-08-12","2021-03-12","2021-03-12","2021-03-12","2021-05-05","2021-08-12","2020-02-16","2020-11-30","2020-04-03","2020-04-03","2020-11-06","2020-11-06"],"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":[["","10370010103","BUPROPN ","150MG XL","30","Select","Select",""],["","59651001890","NIACIN ","500MG ER","60","Select","Select",""],["","69618004610","ASPIRIN ","81MG EC","30","Select","Select",""],["","00832003850","OXYBUTYNIN ","5MG","30","Select","Select",""],["","63304062410","FUROSEMIDE ","20MG","30","Select","Select",""],["","59746033510","LOSARTAN ","100MG","30","Select","Select",""],["","69097012815","AMLODIPINE ","10MG","30","Select","Select",""],["","65862052405","GABAPENTIN ","800MG","135","Select","Select",""],["","29300022010","MONTELUKAST ","10MG","30","Select","Select",""],["","53746011005","HYDROCO\/APAP ","10-325MG","120","Select","Select",""],["","00093585201","ESCITALOPRAM ","20MG","30","Select","Select",""],["","62011017301","HM ","21MG\/24H","28","Select","Select",""],["","00185067401","HYDROXYZ ","25MG","30","Select","Select",""],["","00781540192","ROSUVASTATIN ","10MG","30","Select","Select",""],["","00378363705","CETIRIZINE ","10MG","30","Select","Select",""],["","50111043403","TRAZODONE ","100MG","60","Select","Select",""],["","60258017101","MAG ","400MG","60","Select","Select",""],["","51672404806","CLOTRIM\/BETA ","DIPROP","15","Select","Select",""],["","00832046560","NYAMYC ","100000","60","Select","Select",""],["","00185062010","LISINOPRIL ","20MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","45802005911","NYSTATIN ","100000","30","Select","Select",""],["","50111039801","HYDRALAZINE ","10MG","60","Select","Select",""],["","00603221432","AMITRIPTYLIN ","50MG","30","Select","Select",""],["","00006011731","SINGULAIR ","10MG","90","Select","Select",""],["","51672125902","CLOBETASOL ","0.05%","60","Select","Select",""],["","70010075405","METHOCARBAM ","500MG","120","Select","Select",""],["","00169406012","VICTOZA ","18MG\/3ML","6","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120","Select","Select",""],["","08470359001","UNIFINE ","31GX6MM","100","Select","Select",""],["","00185062010","LISINOPRIL","20MG","30","Select","Select",""],["","50111039801","HYDRALAZINE","10MG","60","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00185067401","HYDROXYZ","25MG","30","Select","Select",""],["","00781540192","ROSUVASTATIN","10MG","30","Select","Select",""],["","59746033510","LOSARTAN","100MG","30","Select","Select",""],["","00378363705","CETIRIZINE","10MG","30","Select","Select",""],["","69097012815","AMLODIPINE","10MG","30","Select","Select",""],["","65862052405","GABAPENTIN","800MG","135","Select","Select",""],["","29300022010","MONTELUKAST","10MG","30","Select","Select",""],["","00832003850","OXYBUTYNIN","5MG","30","Select","Select",""],["","62011017301","HM","21MG\/24H","28","Select","Select",""],["","00093585201","ESCITALOPRAM","20MG","30","Select","Select",""],["","63304062410","FUROSEMIDE","20MG","30","Select","Select",""],["","50111043403","TRAZODONE","100MG","60","Select","Select",""],["","60258017101","MAG","400MG","60","Select","Select",""],["","53746011005","HYDROCO\/APAP","10-325MG","120","Select","Select",""],["","45802005911","NYSTATIN","100000","30","Select","Select",""],["","10370010103","BUPROPN","150MG XL","30","Select","Select",""],["","00832046560","NYAMYC","100000","60","Select","Select",""],["","51672404806","CLOTRIM\/BETA","DIPROP","15","Select","Select",""],["","59651001890","NIACIN","500MG ER","60","Select","Select",""],["","69618004610","ASPIRIN","81MG EC","30","Select","Select",""],["","00006011731","SINGULAIR","10MG","90","Select","Select",""],["","00603221432","AMITRIPTYLIN","50MG","30","Select","Select",""],["","70010075405","METHOCARBAM","500MG","120","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","120","Select","Select",""],["","51672125902","CLOBETASOL","0.05%","60","Select","Select",""],["","08470359001","UNIFINE","31GX6MM","100","Select","Select",""],["","00169406012","VICTOZA","18MG\/3ML","6","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","",""],["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":""}]}]}