{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TARAS   L DUNGEE","gend":0,"add":"1414 HANOVER AVE NW APT A","city":"ROANOKE","state":"VA","zip":"24017-9998","dob":"1963-09-05","age":"","mstatus":"","insh":"2144256*01","cliId":"","pno":"540\/676-6444","cno":"540\/676-6444","email":"","ename":"","eno":"","pphy":"DRAKE, CHANTELLE H NP","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":"M4","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":["S62.643A","M17.0","M76.51","M76.52","F17.219","M25.531","M79.89","R35.0","N52.9","M17.11","V54.12","Z87.891","Z87.898","I10.","Z09.","M17.12","M19.031","M25.562","T50.901A","T68.XXXA","R41.82","M19.131","S62.001S","G93.40","F12.10","Z86.59","Z47.1","Z96.652","G93.41","J96.01","R68.0","Z87.11","Z01.818","R94.31","M25.561","M25.532","G89.29","K21.9","Z88.6","Z88.0","F41.9","Z86.010","Z00.00","I49.3","I45.89","Z72.0","L98.9"],"date":["2020-05-04","2021-01-04","2020-11-09","2020-11-09","2020-11-09","2021-11-17","2021-08-17","2022-06-14","2022-06-14","2022-07-13","2020-05-26","2021-02-04","2020-11-24","2020-11-24","2020-11-24","2021-02-04","2021-10-05","2022-06-14","2020-03-12","2020-03-12","2020-03-12","2022-07-19","2022-07-19","2020-03-18","2020-03-18","2020-03-13","2021-06-16","2021-06-16","2020-03-13","2020-03-13","2020-03-13","2020-03-13","2021-01-28","2021-01-28","2022-06-14","2021-11-17","2022-06-14","2021-02-04","2021-02-04","2021-02-04","2021-07-16","2021-07-16","2022-06-14","2020-03-12","2020-03-12","2020-07-22","2022-09-01"],"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":[["","00378668999","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","60505384901","CELECOXIB","CAP 200MG","60","Select","Select",""],["","69097096607","NABUMETONE","TAB 750MG","60","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","12","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","24","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","28","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","68180071909","AMLODIPINE","TAB 2.5MG","30","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","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":""}]}]}