{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANICE   L MOWLES","gend":1,"add":"2033 MOUNTAIN PASS ROAD","city":"TROUTVILLE","state":"VA","zip":"24175-9998","dob":"1967-10-30","age":"","mstatus":"","insh":"20048268*01","cliId":"","pno":"540\/819-3737","cno":"540\/819-3737","email":"","ename":"","eno":"","pphy":"SCHLEUPNER, MARK A MD","ppno":"540\/224-3870","pcpadd":"615 MCDOWELL AVE","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24016,"pcpcounty":"","pcpid":143894,"pcpname":"Carilion Clinic Internal Medicine Riverside 3","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","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":["R10.32","J44.9","F41.8","K21.9","Z01.810","M20.11","R00.1","D48.5","Z01.812","H60.311","G47.33","F32.89","M62.81","M25.551","R26.81","R26.89","R29.3","M54.5","M19.071","M21.611","R06.02","H92.01","Z87.891","I10.","M47.816","Z72.0","Z71.6","E66.01","Z68.41","L02.211","M19.049","M54.31","Z68.39","K85.90","K57.30","Z66.","Z20.828","T38.3X5A","K86.9","K29.80","K21.0","F31.9","F41.9","G89.29","Z88.6","Z85.41","T40.2X5A","H66.004","F32.9","F17.210","R10.84","R74.8","R11.0","Z01.818","Z00.00","R10.9","Z48.89","M20.12","Z98.890","M43.16","M54.12","R73.03","E55.9","R10.13","Z12.31","F12.10","Z68.38","Z99.89","M75.102","Q66.211","M72.2","M79.604","L73.2","R25.2","R79.9","H54.3","M48.02","M50.30","R13.10","J02.9","M47.817","M43.17","M50.10","M47.22","G47.30","E03.9","E66.9","Z87.442","Z20.822","Z86.718","R94.31","K76.6","K29.70","K31.89","M50.222","M50.223","NO DATA","M51.36","R13.12","Z86.010","K29.50","M19.90","G43.909","Z23.","J45.20","F43.10","M54.42","M62.838","M54.41"],"date":["2020-09-29","2021-10-21","2020-09-29","2021-10-21","2021-10-04","2021-02-02","2021-10-04","2021-04-20","2021-11-04","2021-06-02","2021-10-25","2021-09-16","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2021-08-05","2020-12-30","2020-12-30","2021-05-10","2021-09-16","2021-07-01","2021-10-06","2020-01-06","2020-01-06","2020-01-06","2021-10-06","2021-10-21","2020-02-17","2020-08-31","2020-08-31","2021-10-06","2020-10-07","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2021-10-06","2020-09-28","2020-09-28","2020-09-28","2021-05-25","2021-10-06","2020-04-29","2020-09-29","2020-09-29","2020-09-29","2021-11-04","2020-09-14","2020-09-30","2021-03-26","2021-11-09","2021-03-26","2021-08-05","2021-10-06","2021-05-25","2021-09-02","2021-05-25","2021-05-25","2021-09-02","2021-06-23","2021-06-23","2020-01-21","2021-02-02","2020-03-05","2020-06-10","2021-02-24","2021-02-24","2021-02-24","2021-03-09","2021-08-05","2021-09-02","2021-10-21","2021-08-04","2021-07-30","2021-07-30","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-10-21","2021-09-02","2021-11-04","2021-10-21","2021-10-04","2021-10-21","2021-10-21","2021-10-21","2021-10-01","2021-10-01","2021-10-27","2021-10-01","2021-09-22","2021-10-21","2021-10-21","2021-10-21","2021-10-21","2021-09-23","2021-09-23","2021-10-06","2021-10-06","2021-10-06","2021-10-06"],"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":[["","00002143380","TRULICITY ","0.75\/0.5","2","Select","Select",""],["","65862019999","GABAPENTIN ","300MG","90","Select","Select",""],["","68645014059","FAMOTIDINE ","20MG","60","Select","Select",""],["","00069046956","CHANTIX ","1MG","60","Select","Select",""],["","55111017915","TIZANIDINE ","2MG","45","Select","Select",""],["","00143314250","DOXYCYCL ","100MG","28","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","16","Select","Select",""],["","10702001250","HYDROXYZ ","50MG","90","Select","Select",""],["","00169406012","VICTOZA ","18MG\/3ML","6","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","3","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","69097015907","MELOXICAM ","15MG","90","Select","Select",""],["","60505036301","OFLOXACIN ","0.3%OTIC","5","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","08290320109","BD  PEN NEEDL","31GX8MM","100","Select","Select",""],["","11523726803","MIRALAX ","3350 NF","30","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","30","Select","Select",""],["","24208072002","DEXAMETH ","0.1% OP","5","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","21922000201","CLINDAMYCIN ","1%","60","Select","Select",""],["","59779030603","CVS ","","510","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","30","Select","Select",""],["","24208091055","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","00069046956","CHANTIX","1MG","60","Select","Select",""],["","68645014059","FAMOTIDINE","20MG","60","Select","Select",""],["","55111017915","TIZANIDINE","2MG","45","Select","Select",""],["","65862019999","GABAPENTIN","300MG","90","Select","Select",""],["","00002143380","TRULICITY","0.75\/0.5","2","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","16","Select","Select",""],["","00143314250","DOXYCYCL","100MG","28","Select","Select",""],["","10702001250","HYDROXYZ","50MG","90","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","69097015907","MELOXICAM","15MG","90","Select","Select",""],["","00169406012","VICTOZA","18MG\/3ML","6","Select","Select",""],["","08290320109","BD PEN NEEDL","31GX8MM","100","Select","Select",""],["","11523726803","MIRALAX","3350 NF","30","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","14","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","60","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","3","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","21922000201","CLINDAMYCIN","1%","60","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","59779030603","CVS","","510","Select","Select",""],["","60505036301","OFLOXACIN","0.3%OTIC","5","Select","Select",""],["","24208072002","DEXAMETH","0.1% OP","5","Select","Select",""],["","59310058020","PROAIR","","1","Select","Select",""],["","68462018556","FLUOCIN","0.01%","5","Select","Select",""],["","69452015120","VITAMIN","50000UNT","30","Select","Select",""],["","24208091055","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","59310057922","PROAIR ","AER ","8","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","7","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","30","Select","Select",""],["","68462018556","FLUOCIN ","OIL 0.0001","5","Select","Select",""],["","13668013601","ESCITALOPRAM ","TAB 10MG","90","Select","Select",""],["","00832105410","BACLOFEN ","TAB 10MG","90","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":""}]}]}