{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIMBERLY   A WORRELL","gend":1,"add":"3804 YATES ROAD","city":"SHAWSVILLE","state":"VA","zip":"24162-9998","dob":"1991-09-23","age":"","mstatus":"","insh":"2185609*01","cliId":"","pno":"540\/206-3480","cno":"","email":"","ename":"","eno":"","pphy":"BOHON, SONYA N MD","ppno":"540\/484-4800","pcpadd":"SUITE 201 390 SOUTH MAIN ST","pcpcity":"ROCKY MOUNT","pcpstate":"VA","pcpzip":24151,"pcpcounty":"","pcpid":"","pcpname":"Carilion Medical Associates Rocky Mount","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/484-4862","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.20","F15.20","F12.10","F43.10","F32.9","F10.239","F19.10","F41.1","F10.24","F41.0","O99.89","R06.02","Z3A.24","F31.81","R50.9","Z3A.32","S52.602A","F41.9","V62.84","Z20.822","M79.632","R05.","S52.601A","Y09.","O98.42","O98.32","B19.20","O99.343","A60.00","O69.81X0","Z30.2","Z3A.37","Z37.0","Z91.040","L03.011","Z20.828","S60.445A","W49.04XA","S02.2XXA","Z87.891","Z23.","R68.84","F15.10","L03.211","N30.00","F17.210","F10.10","NO DATA","L02.01","L02.413","O42.10","Z3A.00","J06.9","B97.89","R68.89","Z33.1","R30.0","N39.0","Z11.59","F43.8","F33.1","F17.200","S60.945A","Z03.79","O42.92","O63.1","O99.334","Z3A.38","O99.824","F33.2","O9A.519","F22.","F40.218","F41.8","O99.310","O99.340","O47.03","Z3A.36","R10.30","R21.","N76.0","O80.","G40.909","J45.909","F31.9","V48.5XXA"],"date":["2021-10-30","2021-10-30","2021-10-30","2021-02-07","2021-10-30","2021-03-11","2021-03-05","2021-03-11","2021-03-11","2021-03-11","2020-04-20","2020-02-28","2020-02-28","2020-09-04","2021-08-12","2020-04-20","2020-04-21","2021-10-30","2021-03-03","2021-10-22","2021-08-12","2021-08-12","2020-05-08","2020-04-18","2020-05-10","2020-05-10","2020-05-10","2020-05-10","2020-05-10","2020-05-10","2020-05-10","2020-05-10","2020-05-10","2020-05-10","2021-01-27","2021-03-24","2021-06-17","2021-06-17","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2020-03-12","2020-07-16","2021-03-09","2021-03-09","2021-03-09","2021-07-21","2021-05-08","2021-09-04","2020-05-10","2020-05-10","2020-01-03","2020-01-03","2020-04-19","2020-05-08","2020-12-28","2020-12-28","2020-12-28","2021-04-14","2021-04-14","2021-06-17","2021-06-17","2019-06-21","2019-07-07","2019-07-07","2019-07-07","2019-07-07","2019-07-07","2019-10-30","2019-09-29","2019-09-26","2019-09-26","2019-10-26","2019-10-28","2019-10-28","2019-06-21","2019-06-21","2019-08-07","2019-09-26","2019-08-07","2019-07-07","2019-09-26","2019-09-26","2019-09-26","2021-10-01"],"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":{"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":[["","66993068130","OLANZAPINE","TAB 5MG","30","Select","Select",""],["","65862001105","SERTRALINE","TAB 25MG","30","Select","Select",""],["","24385059029","MICONAZOLE","CRE 0.02","45","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","","MUPIROCIN","OIN 0.02","","Select","Select",""],["","00555015902","CHLORDIAZEP","CAP 25MG","33","Select","Select",""],["","65862044990","VALACYCLOVIR","TAB 1GM","21","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","69097015915","MELOXICAM","TAB 15MG","14","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","50580040226","TYLENOL","TAB SEVERE","40","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","65862037301","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","63824000850","MUCINEX","TAB 600MG ER","10","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","14","Select","Select",""],["","00143993905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","70954001910","PRAZOSIN","CAP 1MG","30","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","15","Select","Select",""],["","00135057602","FLONASE","SPR 50MCG","10","Select","Select",""],["","43547033950","RISPERIDONE","TAB 0.25MG","30","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","11845005651","B-1","TAB 100MG","21","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","51645083701","PRENATAL","TAB 28-0.8MG","30","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","00378870006","ACYCLOVIR","OIN 0.05","15","Select","Select",""],["","70700011985","ESTARYLLA","TAB 0.25-35","28","Select","Select",""],["","31604001358","POTASSIUM  GL TAB 5","TAB 550MG","30","Select","Select",""],["","67618010110","COLACE","CAP 100MG","30","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","20","Select","Select",""],["","65862077685","MILI","TAB 0.25\/35","28","Select","Select",""],["","00363013180","WAL-ZAN","TAB ","30","Select","Select",""],["","81421003005","ZANTAC","TAB 75MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","69543026790","PNV","TAB 29-1MG","30","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","60258019309","PRENATABS","TAB ","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":[]}},{"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":""}]}]}