{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRACY   L DEPETRIS","gend":1,"add":"VILLAGE LNDG 181 OAKWOOD DRIVE","city":"MARTINSVILLE","state":"VA","zip":"24112-9998","dob":"1963-12-13","age":"","mstatus":"","insh":"20039133*01","cliId":"","pno":"434\/685-1778","cno":"","email":"","ename":"","eno":"","pphy":"EGGLESTON CLARK, VALENCIA R MD","ppno":"276\/670-3300","pcpadd":"1107 A BROOKDALE ST","pcpcity":"MARTINSVILLE","pcpstate":"VA","pcpzip":24112,"pcpcounty":"","pcpid":"","pcpname":"Carilion Medical Associates Martinsville","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/634-0379","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","H44.23","H25.813","F20.0","C44.622","F20.9","L03.011","Z79.899","L08.9","F31.9","N39.0","E03.8","Z20.822","L20.89","D48.5","L98.9","R82.90","R79.89","E03.9","D53.9","E78.5","N30.00","B96.89","L30.9","I10.","L25.9","E07.9","F99.","E11.9","NO DATA","F17.200"],"date":["2022-02-21","2022-02-21","2022-02-21","2022-09-21","2022-08-24","2022-02-25","2021-11-04","2022-02-25","2021-07-06","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2022-05-11","2022-05-11","2021-02-24","2021-02-24","2021-03-25","2022-02-25","2021-03-25","2022-02-25","2021-03-25","2021-03-25","2021-11-04","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2022-02-25","2022-02-25","2022-02-25"],"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":[]},{"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":[["","00093083201","CLONAZEPAM","TAB 0.5MG","90","Select","Select",""],["","68382008101","HALOPERIDOL","TAB 20MG","31","Select","Select",""],["","33342007107","OLANZAPINE","TAB 15MG","62","Select","Select",""],["","00832712401","DIVALPROEX","TAB 500MG DR","30","Select","Select",""],["","00378181577","LEVOTHYROXIN","TAB 150MCG","30","Select","Select",""],["","63402030630","LATUDA","TAB 60MG","31","Select","Select",""],["","00378819060","CLOBETASOL","OIN 0.0005","60","Select","Select",""],["","00074621553","DEPAKOTE","TAB 500MG DR","30","Select","Select",""],["","00004006801","KLONOPIN","TAB 0.5MG","90","Select","Select",""],["","00378479106","FLUOROURACIL","CRE 0.05","40","Select","Select",""],["","57664037718","TRAMADOL","TAB 50MG","90","Select","Select",""],["","00378342201","NITROFURANTN","CAP 100MG","20","Select","Select",""],["","33342014409","ZIPRASIDONE","CAP 20MG","31","Select","Select",""],["","00121067516","VALPROIC","SOL 250\/5ML","650","Select","Select",""],["","69315090505","LORAZEPAM","TAB 1MG","90","Select","Select",""],["","00093321915","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00093314701","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","16714050101","TERBINAFINE","TAB 250MG","28","Select","Select",""],["","57664078586","CLONAZEP","TAB 0.5MG","60","Select","Select",""],["","59762013105","SILVER","CRE 0.01","50","Select","Select",""],["","00363036506","NICOTINE","GUM 2MG CINN","160","Select","Select",""],["","00378395105","ATORVASTATIN","TAB 20MG","21","Select","Select",""],["","00054001725","PREDNISONE","TAB 10MG","40","Select","Select",""],["","00168041699","TACROLIMUS","OIN 0.001","100","Select","Select",""],["","33342033354","TRIAMCINOLON","OIN 0.001","454","Select","Select",""],["","00904671772","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","96295012782","THERAPEUTIC","","90","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","13107003105","MIRTAZAPINE","TAB 15MG","31","Select","Select",""],["","40985021104","B-12","TAB 1000 CR","90","Select","Select",""],["","00904530680","BANOPHEN","CAP 25MG","90","Select","Select",""],["","00904549213","THERA-M","TAB ","30","Select","Select",""],["","70877858801","TALIVA","CAP ","60","Select","Select",""],["","96295013579","VITAMIN","TAB 1000 TR","30","Select","Select",""],["","70898019809","ONEVITE","TAB ","60","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":""}]}]}