{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TARA PETERS","gend":1,"add":"4830 BLUE RIDGE BLVD 1050 TOWERS RD","city":"BLUE RIDGE","state":"VA","zip":"24064-9998","dob":"1991-12-16","age":"","mstatus":"","insh":"1789035*01","cliId":"","pno":"540\/293-7131","cno":"","email":"","ename":"","eno":"","pphy":"SIMCOX, KIMBERLY P DO","ppno":"540\/985-9715","pcpadd":"102 HIGHLAND AVE SUITE 303","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24013,"pcpcounty":"","pcpid":"","pcpname":"CARILION MEDICAL CENTER","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/985-8487","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","Z51.81","Z79.899","I44.2","R00.0","Z95.0","Z95.4","B18.2","F19.90","F12.90","I10.","J45.30","F32.9","O99.325","R80.9","R94.31","F41.9","N05.9","O99.320","R06.02","R06.9","R06.4","R05.","N87.0","N72.","F17.210","F39.","F12.10","F10.10","F15.10","Z30.09","I49.3","Z30.42","F33.1","F11.21","J45.909","F17.200","Z86.19","Z72.89","F43.21","M25.471","M25.474","M25.475","M25.472","Z76.0","Z01.818","V62.84","F10.920","Z20.822","Z01.812","Z23.","J41.0","Z72.0","B17.10","Z95.3","B19.20","Z86.79"],"date":["2022-11-17","2022-05-12","2022-05-12","2022-11-15","2021-01-18","2022-11-15","2021-01-20","2021-04-06","2021-04-08","2021-07-29","2021-11-03","2021-11-03","2021-09-17","2020-09-01","2020-09-24","2021-09-16","2021-08-12","2021-01-20","2021-05-06","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2020-10-15","2020-10-15","2022-11-15","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2020-12-17","2021-04-27","2021-07-09","2021-08-12","2021-08-12","2021-09-17","2021-09-17","2021-09-17","2020-11-19","2021-08-12","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2020-12-24","2021-02-15","2021-09-16","2021-09-16","2021-09-16","2020-09-24","2021-01-18","2021-01-18","2021-01-18","2020-08-20","2022-11-15","2022-11-15","2022-11-15"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","SUBOXONE","MIS 8-2MG","","Select","Select",""],["","65862052899","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","65162089703","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","00781717612","NALOXONE","SPR 4MG","2","Select","Select",""],["","50111056003","TRAZODONE","TAB 50MG","30","Select","Select",""],["","66993058497","FLUTIC\/SALME","AER 100\/50","60","Select","Select",""],["","00074262528","MAVYRET","TAB 100-40MG","84","Select","Select",""],["","00173069500","ADVAIR","AER 100\/50","60","Select","Select",""],["","","LISINOPRIL","TAB 5MG","","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","","NICOTINE","LOZ 4MG MINT","","Select","Select",""],["","","BUSPIRONE","TAB 5MG","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","59762453802","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","69097012805","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","","SLEEP","TAB 25MG","","Select","Select",""],["","","PYRIDOXINE","TAB 25MG","","Select","Select",""],["","","BUPREN\/NALOX","SUB 8-2MG","","Select","Select",""],["","","FLULAVAL","INJ 2020-21","","Select","Select",""],["","00603254421","BUT\/APAP\/CAF","TAB ","15","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","12","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}