{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TINA   M DAWSON","gend":1,"add":"2110 TINKER DR NE LOT 22","city":"ROANOKE","state":"VA","zip":"24012-9998","dob":"1974-06-28","age":"","mstatus":"","insh":"20048865*01","cliId":"","pno":"540\/682-1584","cno":"","email":"","ename":"","eno":"","pphy":"DULANEY, KIMBERLY A MD","ppno":"540\/427-9200","pcpadd":"2145 MT PLEASANT BLVD","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24014,"pcpcounty":"","pcpid":"","pcpname":"Carilion Clinic Family Medicine Southeast","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/427-3237","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A54.9","I10.","Z79.899","J45.40","R51.9","J06.9","R05.","B97.89","Z72.0","U07.1","Z01.419","Z12.4","L60.0","B35.1","J45.50","G47.33","E66.01","R60.0","F32.1","H10.13","H11.31","Z23.","J45.901","R06.02","R06.2","Z98.890","J45.21","M79.674","M79.675","D64.9","S39.012A","M54.5","J45.909","F17.200","R00.0","R07.89","S80.01XA","S33.5XXA","Z79.51","NO DATA","L91.8","Z11.3","L03.317","R21."],"date":["2021-06-28","2022-03-07","2021-05-17","2022-03-07","2021-08-19","2020-08-22","2020-08-22","2020-08-22","2020-08-22","2020-10-12","2021-11-29","2020-11-23","2020-03-09","2020-03-09","2020-08-03","2022-03-07","2022-03-07","2020-08-03","2020-08-03","2020-08-03","2020-12-01","2022-09-23","2019-11-28","2019-11-28","2019-06-21","2019-09-30","2019-06-24","2019-09-09","2019-09-09","2019-06-21","2019-04-16","2019-04-16","2022-03-01","2019-10-06","2019-10-06","2019-10-06","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-06-15","2022-06-13","2022-09-23","2022-09-23"],"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":[["","69097084507","CYCLOBENZAPR","TAB 5MG","9","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","","FLUOXETINE","CAP 10MG","","Select","Select",""],["","00093742698","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","","SYMBICORT","AER 160-4.5","","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","00378827052","ALBUTEROL","NEB 0.00083","225","Select","Select",""],["","","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","","LISINOPRIL","TAB 20MG","","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","14","Select","Select",""],["","67877025130","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","","OLOPATADINE","DRO 0.001","","Select","Select",""],["","","CVS","GUM 2MG ORIG","","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","60","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","30","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","9","Select","Select",""],["","49281041950","FLUZONE","INJ 2019-20","0","Select","Select",""],["","69097085902","TERBINAFINE","TAB 250MG","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00378967130","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","67877012450","SILVER","CRE 0.01","20","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":""}]}]}