{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KENIA   C VELASQUEZ- RIVERA","gend":1,"add":"2024 INDIAN VILLAGE LN SE","city":"ROANOKE","state":"VA","zip":"24013-9998","dob":"1988-06-09","age":"","mstatus":"","insh":"2277103*01","cliId":"","pno":"540\/904-3870","cno":"540\/904-3870","email":"","ename":"","eno":"","pphy":"RHEA, RANDALL MD","ppno":"540\/983-6700","pcpadd":"415 S POLLARD ST","pcpcity":"VINTON","pcpstate":"VA","pcpzip":24179,"pcpcounty":"","pcpid":147705,"pcpname":"Carilion Family Medicine Parkway Physicians Vinton","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/982-6928","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z31.5","O35.8XX0","V23.89","Z3A.19","Z33.1","Z34.90","K21.9","Z28.21","F41.1","F32.9","Z83.3","N92.6","R10.32","N92.0","R63.5","L65.9","N83.201","N83.299","O99.89","M54.16","M62.81","Z3A.00","O99.340","F43.10","F41.8","G47.00","R73.03","R35.0","N89.8","R10.9","Z86.19","N30.01","M54.5","J30.9","Z20.828","R09.81","R05.","O13.4","O99.344","O98.52","Z37.0","Z3A.38","O99.613","O99.824","B00.9","O99.02","O99.214","O99.62","O99.345","NO DATA","Z01.818","F10.10","Z23.","O99.312","O36.8131","Z30.2","O99.311","L76.82","N94.10","N92.1","R94.31","U07.1","J96.01","R74.01","R59.0","J06.9","R50.9","R06.02","J18.9","R09.1","R09.02","Z09.","Z86.16","R04.2","F41.9","J30.2","A60.09","E66.9","Z68.36","L29.9","H69.83"],"date":["2020-03-02","2020-03-02","2020-06-05","2020-03-02","2020-09-02","2020-09-02","2020-11-06","2020-11-06","2020-11-06","2021-08-14","2020-11-06","2020-11-06","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2021-07-02","2021-04-28","2020-02-05","2020-02-05","2020-02-05","2020-02-05","2020-05-13","2020-07-22","2021-08-18","2020-08-19","2021-08-31","2020-12-18","2020-12-29","2020-12-18","2020-12-18","2020-12-18","2020-12-18","2021-07-12","2021-08-14","2021-10-15","2021-08-09","2020-07-18","2020-07-18","2020-07-18","2020-07-18","2020-07-18","2020-07-18","2020-07-18","2020-07-18","2020-07-18","2020-07-18","2020-07-18","2020-07-22","2021-08-18","2020-09-04","2020-07-14","2020-05-12","2020-06-05","2020-07-17","2020-09-09","2020-06-05","2020-09-30","2021-07-02","2021-07-02","2021-08-13","2021-08-18","2021-08-18","2021-08-18","2021-08-14","2021-08-09","2021-08-09","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-31","2021-08-31","2021-08-14","2021-08-14","2021-08-14","2021-08-14","2021-08-14","2021-08-14","2021-10-15","2021-10-15"],"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":[["","68382079101","ACYCLOVIR ","400MG","60","Select","Select",""],["","87701040751","VITAMIN ","2000UNIT","30","Select","Select",""],["","00536408501","PRENATAL ","28-0.8MG","30","Select","Select",""],["","50428027137","CVS ","27-0.8MG","30","Select","Select",""],["","57664049983","MIRTAZAPINE ","15MG","30","Select","Select",""],["","00093117210","PENICILLN ","250MG","21","Select","Select",""],["","50428895141","MULTSYM ","CHILDRNS","236","Select","Select",""],["","13668001005","CITALOPRAM ","20MG","30","Select","Select",""],["","65862001501","AMOXICILLIN ","875MG","20","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","41167580003","NASACORT ","55MCG\/AC","11","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","10702001250","HYDROXYZ ","50MG","90","Select","Select",""],["","50111064801","FLUOXETINE ","20MG","30","Select","Select",""],["","45802065087","LORATADINE ","10MG","30","Select","Select",""],["","68382000105","PAROXETINE ","40MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","45802048678","DOCUSATE ","100MG","30","Select","Select",""],["","50111043301","TRAZODONE ","50MG","30","Select","Select",""],["","00054418625","DEXAMETHASON ","6MG","5","Select","Select",""],["","67877032005","IBUPROFEN ","600MG","30","Select","Select",""],["","00904671980","ACETAMINOPHE ","325MG","60","Select","Select",""],["","10702001801","OXYCODONE ","5MG","5","Select","Select",""],["","68001025320","FLUCONAZOLE ","150MG","1","Select","Select",""],["","47781030801","NITROFUR ","100MG","20","Select","Select",""],["","00049350079","DIFLUCAN ","150MG","1","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","87701040749","GNP ","1000UNIT","30","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","7","Select","Select",""],["","69543042610","NAPROXEN ","500MG","60","Select","Select",""],["","13668001005","CITALOPRAM","20MG","30","Select","Select",""],["","50428027137","CVS","27-0.8MG","30","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","20","Select","Select",""],["","50428895141","MULTSYM","CHILDRNS","236","Select","Select",""],["","57664049983","MIRTAZAPINE","15MG","15","Select","Select",""],["","41167580003","NASACORT","55MCG\/AC","11","Select","Select",""],["","68382079101","ACYCLOVIR","400MG","60","Select","Select",""],["","87701040751","VITAMIN","2000UNIT","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","10702001250","HYDROXYZ","50MG","90","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","50111064801","FLUOXETINE","20MG","30","Select","Select",""],["","00536408501","PRENATAL","28-0.8MG","30","Select","Select",""],["","68382000105","PAROXETINE","40MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR","10MG","30","Select","Select",""],["","00904671980","ACETAMINOPHE","325MG","60","Select","Select",""],["","45802048678","DOCUSATE","100MG","30","Select","Select",""],["","67877032005","IBUPROFEN","600MG","30","Select","Select",""],["","50111043301","TRAZODONE","50MG","30","Select","Select",""],["","10702001801","OXYCODONE","5MG","5","Select","Select",""],["","00049350079","DIFLUCAN","150MG","1","Select","Select",""],["","47781030801","NITROFUR","100MG","20","Select","Select",""],["","68001025320","FLUCONAZOLE","150MG","1","Select","Select",""],["","45802065087","LORATADINE","10MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","87701040749","GNP","1000UNIT","30","Select","Select",""],["","69543042610","NAPROXEN","500MG","60","Select","Select",""],["","00054418625","DEXAMETHASON","6MG","5","Select","Select",""],["","69097014260","ALBUTEROL","HFA","7","Select","Select",""],["","00093117210","PENICILLN","250MG","21","Select","Select",""],["","68462018556","FLUOCIN ","OIL 0.0001","20","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","",""],["N\/A","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":""}]}]}