{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HEATHER HARRISON","gend":1,"add":"421 ADAMS MARKE DR","city":"BLACKSBURG","state":"VA","zip":"24060-9998","dob":"1975-05-04","age":"","mstatus":"","insh":"1537744*01","cliId":"","pno":5405778750,"cno":5405778750,"email":"","ename":"","eno":"","pphy":"KELLY, DANIEL R MD","ppno":5407313200,"pcpadd":"SUITE 120 701 RANDOLPH ST","pcpcity":"RADFORD","pcpstate":"VA","pcpzip":"24141-9998","pcpcounty":"","pcpid":"","pcpname":"Carilion Healthcare Corp","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5406391048,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","D50.8","E66.01","I50.41","F41.1","Z68.44","K42.9","R10.2","Z01.810","N94.89","R94.31","R07.9","U07.1","Z87.891","R06.02","N83.201","N83.202","R11.2","Z79.84","NO DATA","I50.42","G47.33","Z23.","Z00.00","N80.9","R20.2","E11.65","R10.31","D25.9","N83.209","R07.89","J20.9","R10.13","R07.2","N83.8","R19.09","E66.9","R06.01","J40.","R68.83"],"date":["2023-03-05","2023-02-10","2022-07-15","2021-06-17","2023-02-10","2022-09-15","2021-12-02","2022-09-15","2022-10-11","2022-10-25","2022-10-11","2023-03-05","2022-01-14","2023-03-05","2022-01-11","2022-05-25","2022-05-25","2022-05-25","2023-03-05","2022-05-25","2023-02-10","2023-02-10","2023-02-10","2023-02-10","2023-02-10","2023-02-10","2021-06-17","2022-08-19","2022-10-25","2022-08-19","2023-03-05","2023-03-05","2021-09-14","2022-08-28","2022-08-28","2022-09-15","2022-09-15","2022-09-15","2023-03-05","2023-03-05"],"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":[["","67877041301","METFORMIN","TAB 500MG ER","120","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","4","Select","Select",""],["","00169406013","VICTOZA","3-PAK 0.6 MG\/0.1","27","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","16714020030","ONDANSETRON","TAB 4MG ODT","8","Select","Select",""],["","43547028211","ESCITALOPRAM","TAB 20MG","90","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","08290320119","BD PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","10","Select","Select",""],["","00093505698","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","57664037708","TRAMADOL HCL","TAB 50MG","25","Select","Select",""],["","57896010410","ACETAMINOPHE","TAB 325MG","100","Select","Select",""],["","00536124710","SENEXON-S","TAB 8.6-50MG","30","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","43547028211","ESCITALOPRAM OXALATE","20 MG","30","Select","Select",""],["","67877041301","METFORMIN HCL ER","500 MG","360","Select","Select",""],["","00603533815","PREDNISONE","10 MG","21","Select","Select",""],["","00093505698","ATORVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","00002143380","TRULICITY","0.75MG\/0.5","2","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":""}]}]}