{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KENNETH   W JOYCE","gend":0,"add":"1503 HONEY RD LOT 1","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1995-04-16","age":"","mstatus":"","insh":"20035496*01","cliId":"","pno":"434\/770-4461","cno":"434\/770-4461","email":"","ename":"","eno":"","pphy":"BOHON, SONYA MD","ppno":"540\/483-5277","pcpadd":"180 FLOYD AVE","pcpcity":"ROCKY MOUNT","pcpstate":"VA","pcpzip":24151,"pcpcounty":"","pcpid":122576,"pcpname":"Carilion Medical Associates Rocky Mount","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"000\/000-0000","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/489-6459","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F31.5","F64.0","F43.10","K21.9","Z79.890","M79.7","J30.89","Z79.899","F31.81","L03.031","E66.01","Z68.41","R94.31","L60.0","B34.9","E78.5","J45.909","F32.9","G43.909","Z76.89","E03.9","E78.1","F41.1","F31.4","F64.9","R13.19","R10.9","R14.0","R11.0","K92.1","Z01.89","Z01.810","Z01.812","I10.","H81.10","F32.89","Z20.828","K29.70","K64.9","K58.1","K64.8","E78.2","R53.83","R56.9","F39.","F51.01","G47.00","G43.009","R25.1","G44.201","Z48.00","Z87.891","R10.84","R12.","K29.50","K92.2","R06.83","R13.10","Z78.9","Z48.01","R35.8","R35.1","B35.1","L60.3","Z98.890","R35.0","R36.9","Z23.","R39.9","R30.9","R31.9","G89.29","M54.2","M54.5","G47.30","J30.1","F41.9","R09.81","H92.03","F43.20","F43.0","E66.9","F43.29"],"date":["2021-06-23","2021-06-23","2021-10-25","2021-10-25","2021-09-15","2020-07-31","2021-08-02","2020-12-10","2020-12-10","2021-06-23","2021-04-12","2021-09-23","2021-07-07","2021-06-16","2021-03-31","2020-11-07","2021-09-15","2021-03-11","2021-09-15","2021-09-15","2021-03-11","2021-09-15","2021-03-11","2021-09-20","2021-09-20","2021-09-20","2020-09-16","2021-07-09","2021-07-09","2021-07-09","2020-10-21","2020-09-16","2020-10-16","2020-10-16","2021-03-31","2021-03-31","2021-03-31","2020-10-16","2020-10-21","2020-10-21","2021-07-09","2021-07-09","2020-12-10","2020-11-06","2020-12-10","2020-12-10","2020-12-10","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2020-05-09","2020-05-09","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-11-06","2021-04-29","2021-06-25","2020-05-09","2021-05-07","2021-05-07","2021-08-25","2021-08-25","2021-08-25","2020-08-17","2020-08-17","2020-08-17","2021-01-04","2021-01-04","2021-01-04","2021-05-14","2021-05-14","2021-05-14","2021-06-29","2021-06-29","2021-09-02","2021-07-30","2021-08-11","2021-07-11","2021-08-31","2021-06-14","2021-07-11"],"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":[["","65862019405","FLUOXETINE ","40MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","30","Select","Select",""],["","70954002010","PRAZOSIN ","2MG","30","Select","Select",""],["","63402030430","LATUDA ","40MG","30","Select","Select",""],["","61874013030","VRAYLAR ","3MG","30","Select","Select",""],["","29300014001","DIVALPROEX ","500MG DR","60","Select","Select",""],["","60505009500","DOXAZOSIN ","4MG","30","Select","Select",""],["","00378932032","WIXELA ","100\/50","60","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","10702001050","HYDROXYZ ","10MG","90","Select","Select",""],["","53746051501","SPIRONOLACT ","100MG","30","Select","Select",""],["","45802091987","CETIRIZINE ","10MG","30","Select","Select",""],["","00555088702","ESTRADIOL ","2MG","90","Select","Select",""],["","13668013601","ESCITALOPRAM ","10MG","30","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22","Select","Select",""],["","00169280015","SAXENDA ","18MG\/3ML","15","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","43598029390","PREGABALIN ","75MG","60","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","30","Select","Select",""],["","00591044401","GUANFACINE ","1MG","60","Select","Select",""],["","52937000120","VASCEPA ","1GM","120","Select","Select",""],["","43386005019","GAVILYTE-N ","FLAV PK","4000","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","8","Select","Select",""],["","69097012303","TOPIRAMATE ","50MG","60","Select","Select",""],["","45802086866","POLYETH ","3350 NF","30","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","90","Select","Select",""],["","16729004617","ATORVASTATIN ","40MG","30","Select","Select",""],["","45802048678","DOCUSATE ","100MG","90","Select","Select",""],["","51991081403","AZELASTINE ","0.10%","90","Select","Select",""],["","60505384901","CELECOXIB ","200MG","30","Select","Select",""],["","00143122701","DICYCLOMINE ","20MG","120","Select","Select",""],["","75826011410","PHENAZOPYRID ","100MG","9","Select","Select",""],["","59088081907","LIDOCAINE\/HC ","3%-0.5%","255","Select","Select",""],["","00378180010","LEVOTHYROXIN ","25MCG","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","2","Select","Select",""],["","72618300002","NURTEC ","75MG ODT","8","Select","Select",""],["","58160084252","BOOSTRIX ","","0","Select","Select",""],["","00023650110","UBRELVY ","100MG","12","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","60","Select","Select",""],["","43386031214","GAVILAX ","","510","Select","Select",""],["","00054050823","ICOSAPENT ","1GM","120","Select","Select",""],["","65162044210","MECLIZINE ","25MG","60","Select","Select",""],["","16729020001","BUSPIRONE ","5MG","60","Select","Select",""],["","00115166003","PROPRANOLOL ","20MG","60","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","50428051108","MELATONIN ","5MG","60","Select","Select",""],["","10702002501","PHENTERMINE ","37.5MG","30","Select","Select",""],["","50428050854","CVS ","","90","Select","Select",""],["","69315090405","LORAZEPAM ","0.5MG","20","Select","Select",""],["","65862001501","AMOXICILLIN ","875MG","14","Select","Select",""],["","00536105227","PEG3350 ","","1020","Select","Select",""],["","67877057305","BENZONATATE ","100MG","90","Select","Select",""],["","33332032101","AFLURIA ","2021-22","0","Select","Select",""],["","29300014001","DIVALPROEX","500MG DR","60","Select","Select",""],["","60505009500","DOXAZOSIN","4MG","30","Select","Select",""],["","00378932032","WIXELA","100\/50","60","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00555088702","ESTRADIOL","2MG","60","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","53746051501","SPIRONOLACT","100MG","60","Select","Select",""],["","61874013030","VRAYLAR","3MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","30","Select","Select",""],["","65862019405","FLUOXETINE","40MG","30","Select","Select",""],["","67877057305","BENZONATATE","100MG","90","Select","Select",""],["","68382018205","BUSPIRONE","15MG","90","Select","Select",""],["","00378230201","PRAZOSIN","2MG","30","Select","Select",""],["","63402030230","LATUDA","20MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","30","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","10702001050","HYDROXYZ","10MG","30","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","69097012303","TOPIRAMATE","50MG","60","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","30","Select","Select",""],["","00591044401","GUANFACINE","1MG","60","Select","Select",""],["","69097094312","GABAPENTIN","300MG","90","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","8","Select","Select",""],["","51991081403","AZELASTINE","0.10%","30","Select","Select",""],["","00169280015","SAXENDA","18MG\/3ML","15","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","20","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","90","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","52937000120","VASCEPA","1GM","120","Select","Select",""],["","43598029390","PREGABALIN","75MG","60","Select","Select",""],["","43386005019","GAVILYTE-N","FLAV PK","4000","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","58160084252","BOOSTRIX","","0","Select","Select",""],["","00378180010","LEVOTHYROXIN","25MCG","30","Select","Select",""],["","00143122701","DICYCLOMINE","20MG","60","Select","Select",""],["","45802048678","DOCUSATE","100MG","30","Select","Select",""],["","45802086866","POLYETH","3350 NF","30","Select","Select",""],["","00054050823","ICOSAPENT","1GM","120","Select","Select",""],["","65162044210","MECLIZINE","25MG","60","Select","Select",""],["","60505384901","CELECOXIB","200MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","60","Select","Select",""],["","50428051108","MELATONIN","5MG","60","Select","Select",""],["","00115166003","PROPRANOLOL","20MG","60","Select","Select",""],["","10702002501","PHENTERMINE","37.5MG","30","Select","Select",""],["","59088081907","LIDOCAINE\/HC","3%-0.5%","255","Select","Select",""],["","00023650110","UBRELVY","100MG","12","Select","Select",""],["","72618300002","NURTEC","75MG ODT","8","Select","Select",""],["","00536105227","PEG3350","","1020","Select","Select",""],["","43386031214","GAVILAX","","1020","Select","Select",""],["","50428050854","CVS","","90","Select","Select",""],["","13107008305","LORAZEPAM","0.5MG","14","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","14","Select","Select",""],["","33332032101","AFLURIA","2021-22","0","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","90","Select","Select",""],["","75826011410","PHENAZOPYRID","100MG","9","Select","Select",""],["","00456120330","LINZESS ","CAP 72MCG","30","Select","Select",""],["","00168008031","HYDROCORT ","CRE 0.025","30","Select","Select",""],["","23155060601","GLYCOPYRROL ","TAB 1MG","30","Select","Select",""],["","62756018388","OXCARBAZEPIN ","TAB 150MG","60","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0","Select","Select",""],["","16729011917","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","69097015915","MELOXICAM ","TAB 15MG","30","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","",""],["No","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":""}]}]}