{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JULIE   M CUNNINGHAM","gend":1,"add":"PO BOX 316","city":"WOOLWINE","state":"VA","zip":"24185-9998","dob":"1973-02-18","age":"","mstatus":"","insh":"20060375*01","cliId":"","pno":"336\/372-2508","cno":"336\/372-2508","email":"","ename":"","eno":"","pphy":"HORNEY, WAYNE D MD","ppno":"540\/745-2031","pcpadd":"911 E MAIN ST","pcpcity":"FLOYD","pcpstate":"VA","pcpzip":24091,"pcpcounty":"","pcpid":147705,"pcpname":"Carilion Clinic Family Medicine Bridgewater","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/745-4028","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C50.411","C50.911","K86.2","R91.1","Z17.0","C77.3","M12.811","M75.01","M75.41","Z92.3","M75.100","M19.011","Z85.3","M25.511","M25.611","M62.81","G62.9","M79.671","R73.9","M79.672","R11.0","M85.89","L60.9","D70.1","D50.8","G62.0","T45.1X5A","M19.012","M62.838","M54.2","G89.29","Z76.89","C50.111","L91.0","L65.9","H01.136","H01.133","B07.8","R30.0","R82.90","G47.30","Z79.811","H01.022","H01.025","H40.053","H52.03","H52.4","D64.9","J02.0","J06.9","Z20.822","U07.1","R11.2","K86.9"],"date":["2021-09-13","2021-10-04","2021-02-26","2021-02-26","2021-09-13","2021-10-04","2021-05-04","2021-06-01","2020-12-14","2020-11-02","2020-12-14","2020-12-14","2021-04-21","2021-06-01","2021-06-01","2021-06-01","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-07-06","2020-01-09","2020-02-07","2020-08-05","2021-06-04","2021-06-04","2020-12-14","2020-07-16","2020-08-05","2020-07-16","2021-02-26","2021-02-26","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2021-02-26","2021-02-26","2021-02-26","2021-09-13","2020-03-06","2020-03-06","2021-07-06","2021-07-06","2021-07-06","2020-02-07","2021-05-11","2021-08-04","2021-08-04","2021-08-09","2021-08-09","2021-10-04"],"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":[["","65162062711","TRAMADOL ","50MG","60","Select","Select",""],["","45802006335","TRIAMCINOLON ","0.03%","15","Select","Select",""],["","24658031205","DOXYCYCL ","100MG","20","Select","Select",""],["","24208078055","NEO\/BAC\/POLY ","OP","4","Select","Select",""],["","00093081001","NORTRIPTYLIN ","10MG","60","Select","Select",""],["","61314063136","NEO\/POLY\/DEX ","0.1% OP","4","Select","Select",""],["","67877022310","GABAPENTIN ","300MG","60","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","20","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG DR","30","Select","Select",""],["","67877012450","SILVER ","1%","50","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","55111014512","FLUCONAZOLE ","150MG","2","Select","Select",""],["","68382020906","ANASTROZOLE ","1MG","90","Select","Select",""],["","69097031602","EXEMESTANE ","25MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","20","Select","Select",""],["","68180077901","ZOLPIDEM ","6.25MG","30","Select","Select",""],["","60505025103","TIZANIDINE ","2MG","30","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","67877057305","BENZONATATE ","100MG","30","Select","Select",""],["","42806054701","VITAMIN ","1.25MG","12","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00186037220","SYMBICORT ","80-4.5","10","Select","Select",""],["","00310737220","BUDES\/FORMOT ","80-4.5","10","Select","Select",""],["","45802006335","TRIAMCINOLON","0.03%","15","Select","Select",""],["","24658031205","DOXYCYCL","100MG","20","Select","Select",""],["","00093081001","NORTRIPTYLIN","10MG","60","Select","Select",""],["","24208078055","NEO\/BAC\/POLY","OP","4","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG DR","90","Select","Select",""],["","61314063136","NEO\/POLY\/DEX","0.1% OP","4","Select","Select",""],["","65162062711","TRAMADOL","50MG","60","Select","Select",""],["","68382020906","ANASTROZOLE","1MG","90","Select","Select",""],["","67877022310","GABAPENTIN","300MG","60","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","69097084507","CYCLOBENZAPR","5MG","30","Select","Select",""],["","00832059530","EXEMESTANE","25MG","30","Select","Select",""],["","55111015330","ONDANSETRON","4MG","20","Select","Select",""],["","68180077901","ZOLPIDEM","6.25MG","30","Select","Select",""],["","47781030301","NITROFURANTN","100MG","10","Select","Select",""],["","42806054701","VITAMIN","1.25MG","12","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","00310737220","BUDES\/FORMOT","80-4.5","10","Select","Select",""],["","00186037220","SYMBICORT","80-4.5","10","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","67877057305","BENZONATATE","100MG","30","Select","Select",""],["","67877012450","SILVER","1%","50","Select","Select",""],["","60505025103","TIZANIDINE","2MG","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}