{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHERYL COSNER","gend":1,"add":"5 SWALLOW LN","city":"HENRY","state":"VA","zip":"24102-9998","dob":"1961-06-01","age":"","mstatus":"","insh":"20040076*01","cliId":"","pno":"443\/735-2766","cno":"","email":"","ename":"","eno":"","pphy":"UHRIG, JARROD DO","ppno":"540\/224-5170","pcpadd":"3 RIVERSIDE CIR","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24016,"pcpcounty":"","pcpid":"","pcpname":"CARILION MEDICAL CENTER","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/983-8229","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M62.262","I73.9","L97.913","I10.","I70.238","E11.621","L97.813","E11.40","I25.10","I74.3","E11.00","L03.115","I96.","E11.52","L03.012","M21.332","Z47.81","Z89.511","E11.9","F32.9","F41.9","Z86.73","Z79.4","Z89.519","J44.9","R26.2","I50.21","J96.01","J44.1","F17.210","R09.02","I65.21","I11.0","I50.9","G89.4","Z20.822","Z79.891","Z79.82","Z79.899","Z95.820","I50.30","E78.01","I63.9","Z82.49","S88.111A","I65.23","Z72.0","E11.8","E11.3291","E11.3212","S81.801S","M79.604","Z48.812","L97.511","E11.51","J96.91","I69.351","F11.20","I50.23","E11.65","E11.42","E78.5","Z79.02","Z91.11","Z87.891","F17.200","L03.116","G25.0","R06.00","R07.9","Z09.","R73.9","R53.81","T40.601A","F31.30","Z99.81","E11.3293","H52.03","H52.223","H25.11","H57.03","R29.6","Z91.14","NO DATA","I70.291","Z98.890","I70.235","E11.59","D62.","E87.6","Z20.828","R94.31","G47.33","Z86.718","I69.334","V58.89","G92.","J96.21","I50.20","Z01.810","I08.0","L97.919","I70.211","Z23.","R41.82","H25.13","H25.12","G89.29","S81.801A","R60.0","G62.9","I65.29","L97.519","T40.601D","R35.0","Z12.11","Z86.79","R21.","E86.0","R11.2","R19.7","E87.1","H53.8","E08.9","J02.9","R00.0","E10.8","H02.63","M79.671","Z91.19","F32.89","R09.81","Z11.59","R13.10","R56.9","F41.8","F43.10","I16.0","G47.31","H35.013","H02.60","H57.9","M54.89","H53.9","S10.96XA","S30.860A","S80.861A","S80.862A","G47.10","G47.00","F11.90","Z79.84","R10.84","Z74.3","M54.30"],"date":["2020-09-30","2021-09-17","2020-09-30","2021-06-23","2020-10-01","2021-02-05","2020-10-01","2021-04-22","2021-06-23","2020-10-08","2020-10-08","2021-01-21","2021-02-05","2020-11-06","2020-12-31","2020-12-31","2020-12-31","2021-09-17","2021-04-01","2021-02-16","2021-04-01","2021-06-23","2021-06-23","2021-01-21","2021-12-23","2021-02-02","2021-02-24","2021-02-16","2021-02-16","2021-02-16","2021-02-24","2021-04-22","2021-06-01","2021-12-23","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-07-09","2021-07-09","2020-09-23","2020-10-05","2020-10-14","2020-10-14","2021-06-01","2021-02-16","2021-02-16","2021-04-25","2021-02-16","2021-06-23","2021-06-23","2021-02-16","2021-02-16","2020-04-13","2020-10-01","2020-09-23","2020-08-27","2020-11-17","2021-02-15","2021-02-15","2021-02-24","2021-02-24","2021-02-24","2021-04-27","2021-06-01","2021-06-01","2021-04-28","2021-04-28","2021-04-28","2021-09-16","2021-10-26","2020-01-31","2020-01-31","2020-11-04","2020-09-30","2020-09-30","2020-10-06","2020-10-06","2020-11-04","2020-11-04","2020-11-04","2020-11-27","2021-04-22","2021-04-22","2021-06-01","2021-05-14","2021-06-01","2021-06-01","2021-06-01","2021-04-19","2021-10-14","2020-09-23","2020-09-23","2020-09-23","2021-04-25","2021-07-08","2021-10-26","2020-01-24","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-11-04","2021-06-01","2021-06-04","2021-06-04","2021-06-04","2019-05-24","2019-11-18","2019-11-21","2019-11-20","2019-12-10","2019-12-12","2019-12-06","2019-11-10","2019-12-08","2019-12-10","2019-02-19","2019-06-30","2019-11-21","2019-09-23","2019-09-23","2019-09-23","2019-10-11","2019-12-06","2019-12-08","2019-12-08","2019-12-08","2019-12-08","2019-12-08","2019-02-22","2019-02-22","2019-02-22","2019-12-09","2019-05-24","2019-05-24","2019-05-24","2019-05-24","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-11-20","2019-11-20","2019-12-12"],"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":[["","53885024450","ONETOUCH","TES ULTRA","200","Select","Select",""],["","68645059090","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","57237001930","DULOXETINE","CAP 60MG","60","Select","Select",""],["","00904679480","ASPIRIN","CHW 81MG","30","Select","Select",""],["","00406575501","METHADONE","TAB 5MG","90","Select","Select",""],["","68382002310","ATENOLOL","TAB 50MG","180","Select","Select",""],["","68645059354","LISINOPRIL","TAB 40MG","90","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","60","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","30","Select","Select",""],["","00310654004","BYDUREON","INJ 2\/0.85ML","3","Select","Select",""],["","00002880359","HUMULIN","INJ 70\/30KWP","15","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","00169406013","VICTOZA","INJ 18MG\/3ML","6","Select","Select",""],["","80681007200","VITAMIN","TAB 500MCG","30","Select","Select",""],["","00310651201","BYETTA","INJ 5MCG","1","Select","Select",""],["","65162037110","OXYBUTYNIN","TAB 5MG ER","30","Select","Select",""],["","72205000530","ROSUVASTATIN","TAB 40MG","90","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","50228017801","GABAPENTIN","TAB 800MG","90","Select","Select",""],["","00093005405","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","49035019502","EQ","DIS 14MG\/24H","30","Select","Select",""],["","59310057922","PROAIR","AER ","26","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","15","Select","Select",""],["","65862014305","CARVEDILOL","TAB 6.25MG","60","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","45802005935","NYSTATIN","CRE 100000","15","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","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":""}]}]}