{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THANAA OMAR","gend":1,"add":"614 NAHO ST NW","city":"ROANOKE","state":"VA","zip":"24017-9998","dob":"1963-06-05","age":"","mstatus":"","insh":"20042811*01","cliId":"","pno":"540\/525-6071","cno":"","email":"","ename":"","eno":"","pphy":"ISSA, MAYADA H MD","ppno":"540\/224-5170","pcpadd":"3 RIVERSIDE CIR","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24016,"pcpcounty":"","pcpid":"","pcpname":"Carilion Clinic Internal Medicine Riverside 3","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","F41.1","G47.00","E11.69","E66.9","G43.709","K21.9","Z98.84","E56.9","Z86.2","E55.9","F41.8","E65.","M62.08","R73.03","Z59.8","E66.09","I10.","Z68.32","M54.5","G89.29","F33.1","G43.001","Z71.3","Z68.31","R53.1","G45.9","M79.601","M79.604","R20.2","R42.","R41.82","R47.01","R29.90","E78.2","E11.40","F41.9","Z79.4","R06.2","R07.89","E66.01","G47.33","Z68.35","Z99.89","R20.0","F41.0","Z78.9","R31.29","M54.42","M54.41","Z12.11","M47.816","R94.31","R11.2","R04.0","R10.84","M62.81","E53.8","G43.109","R63.8","H60.311","I63.9","I69.259","R10.31","Z68.34","W19.XXXA","E11.9","F32.1","R30.0","R29.91","I05.9","Z01.810","Z68.41","R07.9","R06.00","E78.5","K91.2","E11.8","R51.","H81.49","Z51.89","H91.90","I95.9","R11.0","E16.2","K59.01","M25.511","M25.512","H65.91","M75.101","Z01.84","Z23.","H69.83","V58.89","M19.011","H93.13","H92.03","R06.02","E11.42","K76.0","H90.5","M25.562","M25.561","S43.421A","Z68.38","I25.2","Z71.89","Z01.818","R63.4","E23.6","R26.89","G31.84","H93.299","S43.421S","Z86.73","Z79.84","Z79.82","Z79.51","Z79.899","Z20.822","J20.9","S22.20XA","Z20.828","Z01.419","M12.811","U07.1","G47.30","Z98.0","Z86.16","Z68.30"],"date":["2020-11-05","2022-09-28","2020-10-12","2021-09-16","2022-02-03","2021-01-14","2022-09-08","2022-04-22","2021-04-22","2021-04-22","2021-04-22","2021-09-16","2021-12-17","2021-12-17","2022-04-22","2020-09-10","2022-04-22","2022-09-08","2021-06-24","2021-06-24","2022-11-15","2022-09-28","2022-04-22","2021-09-16","2021-09-16","2022-09-08","2021-10-15","2021-10-19","2021-10-19","2021-12-01","2022-04-27","2021-10-12","2021-10-12","2021-10-12","2021-02-24","2022-09-08","2020-03-11","2020-05-12","2021-05-04","2022-01-26","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2021-10-12","2022-09-28","2021-02-04","2021-05-04","2021-03-02","2021-03-02","2021-05-04","2021-05-04","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2020-08-14","2022-04-21","2020-08-14","2020-10-14","2021-10-12","2021-10-12","2021-10-12","2020-03-13","2020-08-28","2022-02-10","2020-12-01","2020-12-31","2021-10-12","2021-10-12","2019-03-20","2019-06-17","2019-03-20","2022-05-03","2022-09-08","2019-09-23","2019-09-23","2019-02-09","2019-02-09","2019-08-22","2019-02-20","2019-07-02","2019-07-02","2019-07-02","2019-08-01","2022-11-15","2019-08-01","2019-02-20","2019-09-03","2019-10-16","2019-10-16","2019-10-16","2022-09-08","2019-10-17","2019-02-27","2019-02-27","2019-03-15","2019-06-17","2019-06-17","2019-06-17","2019-06-17","2019-06-17","2019-09-05","2019-09-10","2019-02-09","2019-02-14","2019-02-14","2019-02-14","2019-02-28","2022-05-10","2021-12-01","2022-03-01","2022-09-08","2022-09-08","2022-09-08","2022-09-08","2022-09-08","2022-09-08","2022-05-12","2022-03-03","2022-03-03","2022-05-12","2022-02-22","2022-11-15","2022-02-10","2022-05-03","2022-05-03","2022-05-03","2022-04-22"],"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":[["","","GABAPENTIN","CAP 100MG","","Select","Select",""],["","","TOPIRAMATE","TAB 25MG","","Select","Select",""],["","","DULOXETINE","CAP 60MG","","Select","Select",""],["","13668000705","ZOLPIDEM","TAB 5MG","20","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","15","Select","Select",""],["","57664050083","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","6","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","60","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","12","Select","Select",""],["","68382076010","METFORMIN","TAB 1000MG","15","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","51672127304","FLUOCINONIDE","SOL 0.0005","60","Select","Select",""],["","68180016111","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","30","Select","Select",""],["","","SUMATRIPTAN","TAB 25MG","","Select","Select",""],["","65862020390","LOSARTAN","TAB 100MG","30","Select","Select",""],["","37864000104","ACETAMIN","TAB 500MG","180","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","","AMITRIPTYLIN","TAB 10MG","","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","","PAIN","TAB 500MG","","Select","Select",""],["","00378034501","DIAZEPAM","TAB 5MG","60","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","50428027915","CVS","TAB 8.6MG","30","Select","Select",""],["","10702002501","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","60505025303","CLOPIDOGREL","TAB 75MG","20","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","00904679480","ASPIRIN","CHW 81MG","30","Select","Select",""],["","","DAILY","TAB WOMN 50+","","Select","Select",""],["","","HYDROCORT","CRE 0.025","","Select","Select",""],["","68180035202","SERTRALINE","TAB 50MG","45","Select","Select",""],["","","QUETIAPINE","TAB 50MG","","Select","Select",""],["","","VOLTAREN","GEL 0.01","","Select","Select",""],["","","CIPROFLOXACN","SOL 0.3% OP","","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","FLUZONE","INJ 2020-21","","Select","Select",""],["","","DOCUSATE","CAP 100MG","","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","18","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","62559015116","OXYCODONE","SOL 5MG\/5ML","120","Select","Select",""],["","68462047301","URSODIOL","TAB 250MG","60","Select","Select",""],["","65162044210","MECLIZINE","TAB 25MG","60","Select","Select",""],["","50428028552","ACETAMINOPHN","TAB 500MG","120","Select","Select",""],["","00536667101","ZINC","TAB 50MG","30","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}