{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYNTHIA   C PETITT","gend":1,"add":"29 LANGLEY DR","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"1958-03-17","age":"","mstatus":"","insh":"2266963*01","cliId":"","pno":"540\/256-1399","cno":"540\/256-1399","email":"","ename":"","eno":"","pphy":"YOUNG, SCOTT F MD","ppno":"540\/949-8241","pcpadd":"428 S MAGNOLIA AVE","pcpcity":"WAYNESBORO","pcpstate":"VA","pcpzip":22980,"pcpcounty":"","pcpid":"","pcpname":"Carilion Clinic Family Medicine Waynesboro","plan":"OHP","program":"MEDICAID","lob":"M4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/949-5582","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","Z71.6","E78.2","M25.551","M25.552","H60.502","H10.32","E55.9","K21.0","R22.41","R79.89","L28.0","S80.861A","L57.8","Z23.","J41.0","F41.1","I73.9","R01.1","I51.89","I34.0","I35.1","J44.9","I65.22","Z12.11","I70.223","R21.","R73.9","R60.9","F41.9","J42.","F32.9","H60.312","L30.9","I70.213","M79.604","I70.0","I77.1","I70.413","R73.01","M79.605","R31.29","G60.9","F17.210","H61.23","Z00.00","M81.0","Z12.31","J20.9","J44.1","H61.20","R05.","J06.9","M79.89","R60.0","I70.235","I70.212","I70.1","R94.31","Z79.899","Z88.5","I65.29","I71.4","M81.8","Z96.642","G89.29","R93.1"],"date":["2022-10-07","2020-02-06","2022-10-07","2020-04-08","2021-12-14","2020-06-19","2020-06-19","2022-09-06","2020-06-19","2021-03-05","2021-03-05","2022-09-15","2022-09-15","2022-09-15","2022-09-06","2020-01-23","2021-12-14","2022-10-07","2020-01-09","2022-09-06","2020-01-09","2020-01-09","2022-10-07","2021-07-15","2021-01-14","2021-11-18","2022-10-07","2022-08-30","2022-08-30","2020-01-02","2020-01-02","2020-07-09","2020-08-18","2021-07-15","2021-07-15","2021-12-14","2021-12-14","2022-10-07","2021-09-10","2022-10-07","2021-09-10","2022-10-07","2022-10-07","2022-10-07","2020-03-06","2021-07-15","2022-09-06","2022-09-06","2022-05-03","2022-05-03","2020-02-25","2020-02-25","2020-02-25","2021-03-05","2022-07-01","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2022-07-01","2022-06-28","2020-07-09","2020-07-09","2020-07-09","2022-09-06"],"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":[["","00378064110","PREDNISONE","TAB 10MG","30","Select","Select",""],["","70700010917","CLOBETASOL","CRE 0.0005","60","Select","Select",""],["","27808008602","HYD","SUS 10-8\/5ML","60","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00591042405","TRIAMT\/HCTZ","TAB 37.5-25","90","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","13","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","31","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","67877025130","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","62175061846","PANTOPRAZOLE","TAB 20MG","90","Select","Select",""],["","70700026330","LANSOPRAZOLE","CAP 30MG DR","90","Select","Select",""],["","65862078430","ESOMEPRA","CAP 40MG DR","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","65862035790","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","120","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","42037010478","DEBROX","SOL 6.5% OT","15","Select","Select",""],["","00186504031","NEXIUM","CAP 40MG","30","Select","Select",""],["","00065853110","CIPRO","SUS OTIC","10","Select","Select",""],["","00574402435","ERYTHROMYCIN","OIN 5MG\/GM","10","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","69238161503","OFLOXACIN","DRO 0.3%OTIC","10","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":[]}},{"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":""}]}]}