{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JASON   S HICKS","gend":0,"add":"APT 1 PO BOX 351","city":"CEDAR BLUFF","state":"VA","zip":"24609-9998","dob":"1972-03-15","age":"","mstatus":"","insh":"20051705*01","cliId":"","pno":"276\/202-4448","cno":"","email":"","ename":"","eno":"","pphy":"ABBOTT, VALERIE LYNN NP","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":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/983-8214","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F41.1","F43.10","F31.9","F12.21","F10.21","F11.21","Z72.811","Z59.6","Z65.2","M51.26","G47.30","M54.2","M25.512","G47.33","G47.11","I10.","E78.5","M51.9","M62.81","M54.5","M51.36","Z98.890","N40.1","R53.82","R39.11","R35.1","E78.2","R19.7","N40.0","Z23.","R20.2","K62.89","K64.8","K62.5","K58.0","Z86.19","G89.4","Z79.899","Z72.0","M50.30","R19.5","J30.2","A04.72","R35.0","Z01.810","NO DATA","I49.9","M54.41","B34.9","J02.9","M54.16","M50.00","R51.9","M54.12","F60.9","J44.9","G89.29","K21.9","Z88.1","J20.9","R05.9"],"date":["2022-10-21","2022-10-21","2022-10-21","2022-06-23","2022-10-21","2022-10-21","2022-10-21","2022-06-15","2022-06-15","2022-06-15","2021-05-11","2022-06-23","2022-01-27","2020-11-25","2021-09-29","2020-02-14","2022-06-23","2022-06-23","2022-06-30","2021-01-04","2021-01-04","2021-12-09","2021-01-04","2021-08-19","2021-08-10","2021-08-10","2021-08-10","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2020-01-21","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-04-07","2021-04-12","2022-06-23","2022-06-23","2022-03-22","2021-03-05","2021-03-05","2021-05-11","2021-05-11","2020-04-07","2022-06-23","2020-04-07","2022-06-23","2021-04-16","2021-04-16","2020-02-13","2022-06-08","2022-05-03","2022-05-24","2022-06-23","2022-06-23","2022-06-23","2022-06-23","2022-06-23","2022-04-25","2022-04-25"],"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":{"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":[["","68001018200","QUETIAPINE","TAB 200MG","30","Select","Select",""],["","43547039950","CYCLOBENZAPR","TAB 5MG","90","Select","Select",""],["","00406012405","HYDROCO\/APAP","TAB 7.5-325","10","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","270","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","13107003205","MIRTAZAPINE","TAB 45MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00185061505","HYDROXYZ","CAP 50MG","90","Select","Select",""],["","00904671740","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","68001041408","DULOXETINE","CAP 30MG","30","Select","Select",""],["","65862050301","AMOX\/K","TAB 875-125","14","Select","Select",""],["","68382070718","DOXYCYC","CAP 100MG","20","Select","Select",""],["","27808005701","PROMETHAZINE","SOL DM","140","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","10","Select","Select",""],["","70010075405","METHOCARBAM","TAB 500MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","65862001905","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","16714004107","ALLOPURINOL","TAB 100MG","60","Select","Select",""],["","16571041210","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0","Select","Select",""],["","68180016613","VANCOMYCIN","CAP 125MG","40","Select","Select",""],["","59310058020","PROAIR","AER ","1","Select","Select",""],["","00228299650","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","16714068303","SIMVASTATIN","TAB 20MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG DR","30","Select","Select",""],["","00406117003","NALTREXONE","TAB 50MG","30","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","68645055354","LISINOPRIL","TAB 20MG","60","Select","Select",""],["","00527128201","DICYCLOMINE","TAB 20MG","60","Select","Select",""],["","69543038810","KETOROLAC","TAB 10MG","15","Select","Select",""],["","00591024201","LORAZEPAM","TAB 2MG","1","Select","Select",""],["","49035045875","ALLERGY","TAB 10MG","90","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","49035037730","EQ","TAB 8.6-50MG","30","Select","Select",""],["","00832105415","BACLOFEN","TAB 10MG","90","Select","Select",""],["","64980032430","PROCTOZONE","CRE -HC 2.5%","30","Select","Select",""],["","68001028103","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","72205002790","ROSUVASTATIN","TAB 5MG","90","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":""}]}]}