{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KARI M MARSHALL","gend":1,"add":"1185 CEDAR ST","city":"CHRISTIANSBURG","state":"VA","zip":"24073-9998","dob":"1983-07-17","age":"","mstatus":"","insh":"1539085*01","cliId":"","pno":5402519140,"cno":5402519140,"email":"","ename":"","eno":"","pphy":"KADIRI, MOHAMED MD","ppno":5403816000,"pcpadd":"205 ROANOKE ST,","pcpcity":"CHRISTIANSBURG","pcpstate":"VA","pcpzip":"24073-9998","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":5403812989,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.1","Z79.899","F31.9","F41.1","K59.09","E78.5","E55.9","Z00.00","M23.91","M94.261","M22.41","M79.4","M54.16","G89.29","M96.1","NO DATA","Z79.891","M17.11","R07.89","R00.0","M54.5","S83.261A","I08.1","R06.02","R07.9","Z30.9","S83.262A","S96.912A","S82.832A","W19.XXXA","R00.2","R94.31","T88.7XXA","D63.8","K21.9","Z30.42","M25.561","M70.51","G89.4","Z51.81","I49.1","Z20.822","Z01.812","J01.90","F33.1","J20.8","Z23.","R42.","E88.81","D22.39","M23.41","I10.","E66.01","Z68.42","Z98.84","I95.1","G56.21","M25.531","S83.281A","S82.839A","M25.572","R60.0","F11.10","R07.2"],"date":["2021-08-24","2022-10-04","2021-05-12","2022-03-03","2021-05-12","2022-04-20","2022-10-04","2021-07-21","2021-08-31","2021-10-26","2021-10-26","2021-10-26","2023-08-15","2022-07-21","2022-07-21","2022-07-21","2022-07-21","2022-07-21","2021-03-09","2022-03-31","2021-08-17","2021-10-26","2022-03-21","2022-04-05","2022-04-05","2022-04-05","2021-09-15","2021-12-14","2021-12-14","2021-12-14","2022-04-20","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2022-10-04","2021-08-11","2021-08-11","2021-12-07","2022-06-22","2022-03-31","2022-03-31","2022-03-31","2022-06-15","2022-08-23","2022-10-04","2022-10-04","2022-03-04","2022-04-20","2021-04-01","2021-10-26","2021-10-26","2021-12-09","2021-12-09","2021-10-26","2022-03-03","2022-08-26","2022-08-26","2021-10-26","2021-12-17","2021-12-17","2021-12-17","2022-04-20","2022-04-20"],"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":[["","68001024604","ONDANSETRON","TAB 4MG ODT","60","Select","Select",""],["","68001016208","PROMETHAZINE","TAB 25MG","60","Select","Select",""],["","55111018010","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","00185067405","HYDROXYZ PAM","CAP 25MG","60","Select","Select",""],["","54092060601","XIIDRA","DRO 0.05","60","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","42858010450","OXYCOD\/APAP","TAB 10-325MG","120","Select","Select",""],["","69238207701","PROPRANOLOL","TAB 10MG","180","Select","Select",""],["","68382092386","ELETRIPTAN","TAB 40MG","6","Select","Select",""],["","00456120230","LINZESS","290 MCG","30","Select","Select",""],["","13668000801","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","69680011225","CYANOCOBALAM","INJ 1000MCG","1","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","120","Select","Select",""],["","00406831501","MORPHINE SUL","TAB 15MG ER","60","Select","Select",""],["","67877026218","RIZATRIPTAN","10 MG","9","Select","Select",""],["","55111029336","SUMATRIPTAN","TAB 100MG","30","Select","Select",""],["","29300011416","LAMOTRIGINE","200 MG","60","Select","Select",""],["","00093342510","LORAZEPAM","0.5 MG","90","Select","Select",""],["","68001018103","QUETIAPINE","TAB 400MG","30","Select","Select",""],["","68001041405","DULOXETINE","CAP 30MG","30","Select","Select",""],["","00574200802","NYSTOP","POW 100000","60","Select","Select",""],["","43598021025","SSD","CRE 0.01","50","Select","Select",""],["","33342032715","TRIAMCINOLON","CRE 0.00025","15","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","10","Select","Select",""],["","63044040101","VITAMIN D3","CAP 10000UNT","30","Select","Select",""],["","67877012425","SILVER SULFA","CRE 0.01","50","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00169406013","VICTOZA","3-PAK 0.6 MG\/0.1","9","Select","Select",""],["","59267100003","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","46122007772","CALCIUM","600 MG","90","Select","Select",""],["","00548540000","MEDROXYPR AC","INJ 150MG\/ML","1","Select","Select",""],["","00023916360","RESTASIS","EMU 0.0005","60","Select","Select",""],["","74312035873","D3","CAP 250MCG","30","Select","Select",""],["","08290320119","BD PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","68001000501","METHYLPRED","TAB 4MG","21","Select","Select",""],["","42806071505","BENZONATATE","200 MG","20","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00049234045","RELPAX","TAB 40MG","6","Select","Select",""],["","00904675180","ASPIRIN LOW","TAB 81MG EC","60","Select","Select",""],["","00904585561","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","60505620202","CYCLOSPORINE","EMU 0.05% OP","60","Select","Select",""],["","00781717612","NALOXONE","SPR ","2","Select","Select",""],["","64980033901","MAGNESIUM-OX","TAB 400MG","60","Select","Select",""],["","60505257808","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","67877069601","CHLORTHALID","TAB 25MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","15","Select","Select",""],["","59651005290","EZETIMIBE","10 MG","30","Select","Select",""],["","80777028299","MODERNA BIVA","INJ BA4\/BA5","0","Select","Select",""],["","68001050103","METOPROL SUC","TAB 50MG ER","60","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","1","Select","Select",""],["","69543021712","MAG OXIDE","TAB 400MG","120","Select","Select",""],["","55111018010","TIZANIDINE HCL","4 MG","90","Select","Select",""],["","00406831501","MORPHINE SULFATE ER","15 MG","60","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","65862016001","ZOLPIDEM TARTRATE","10 MG","30","Select","Select",""],["","74312035873","VITAMIN D","3 250 MCG","30","Select","Select",""],["","00406324301","HYDROMORPHONE HCL","2 MG","120","Select","Select",""],["","68001041404","DULOXETINE HCL","30 MG","30","Select","Select",""],["","00904672852","SUDOGEST","60 MG","30","Select","Select",""],["","68001018203","QUETIAPINE FUMARATE","200 MG","30","Select","Select",""],["","68001024604","ONDANSETRON ODT","4 MG","90","Select","Select",""],["","60505258008","ATORVASTATIN CALCIUM","40 MG","30","Select","Select",""],["","00069034530","PAXLOVID (EUA)","300-100 MG","30","Select","Select",""],["","69680011225","CYANOCOBALAMIN INJECTION","1000MCG\/ML","1","Select","Select",""],["","00054001925","PREDNISONE","50 MG","5","Select","Select",""],["","33342032715","TRIAMCINOLONE ACETONIDE","0.025 %","15","Select","Select",""],["","69238207701","PROPRANOLOL HCL","10 MG","60","Select","Select",""],["","45802081184","NALOXONE HCL","4 MG","2","Select","Select",""],["","69315030660","NYSTATIN","100000\/G","60","Select","Select",""],["","00574200802","NYSTOP POW","100000","60","Select","Select",""],["","68001016208","PROMETHAZINE TAB","25MG","60","Select","Select",""],["","68001041405","DULOXETINE CAP","30MG","30","Select","Select",""],["","00548540000","MEDROXYPR AC INJ","150MG\/ML","1","Select","Select",""],["","68001018203","QUETIAPINE TAB","200MG","30","Select","Select",""],["","69238207701","PROPRANOLOL TAB","10MG","180","Select","Select",""],["","29300011416","LAMOTRIGINE TAB","200MG","60","Select","Select",""],["","00456120230","LINZESS CAP","290MCG","30","Select","Select",""],["","08290320119","BD PEN NEEDL MIS","31GX5MM","100","Select","Select",""],["","33342032715","TRIAMCINOLON CRE","0.025%","15","Select","Select",""],["","68001024604","ONDANSETRON TAB","4MG ODT","60","Select","Select",""],["","00093342510","LORAZEPAM TAB","0.5MG","90","Select","Select",""],["","00406324301","HYDROMORPHON TAB","2MG","120","Select","Select",""],["","00169406013","VICTOZA INJ","18MG\/3ML","9","Select","Select",""],["","65862016001","ZOLPIDEM TAB","10MG","30","Select","Select",""],["","69680011225","CYANOCOBALAM INJ","1000MCG","1","Select","Select",""],["","55111018010","TIZANIDINE TAB","4MG","90","Select","Select",""],["","00049234045","RELPAX TAB","40MG","6","Select","Select",""],["","00406831501","MORPHINE SUL TAB","15MG ER","60","Select","Select",""],["","00185067405","HYDROXYZ PAM CAP","25MG","60","Select","Select",""],["","55111029336","SUMATRIPTAN TAB","100MG","30","Select","Select",""],["","67877026218","RIZATRIPTAN TAB","10MG","9","Select","Select",""],["","00023916360","RESTASIS EMU","0.05%","60","Select","Select",""],["","46122007772","CALCIUM TAB","600MG","30","Select","Select",""],["","60505620202","CYCLOSPORINE EMU","0.05% OP","60","Select","Select",""],["","60505258008","ATORVASTATIN TAB","40MG","30","Select","Select",""],["","64980033901","MAGNESIUM-OX TAB","400MG","60","Select","Select",""],["","00781717612","NALOXONE SPR","","2","Select","Select",""],["","74312035873","D","3 CAP 250MCG","30","Select","Select",""],["","59651005290","EZETIMIBE TAB","10MG","30","Select","Select",""],["","67877069601","CHLORTHALID TAB","25MG","30","Select","Select",""],["","62332042771","BENZONATATE CAP","200MG","30","Select","Select",""],["","67877021905","CEPHALEXIN CAP","500MG","15","Select","Select",""],["","82607066026","FLOWFLEX KIT TEST","","1","Select","Select",""],["","68382092386","ELETRIPTAN TAB","40MG","6","Select","Select",""],["","68001050103","METOPROL SUC TAB","50MG ER","60","Select","Select",""],["","80777028299","MODERNA BIVA INJ BA","4\/BA5","0","Select","Select",""],["","69543021712","MAG OXIDE TAB","400MG","120","Select","Select",""],["","68382092386","ELETRIPTAN HBR","40 MG","6","Select","Select",""],["","65862064163","AZITHROMYCIN","250 MG","6","Select","Select",""],["","55111029398","SUMATRIPTAN SUCCINATE","100 MG","9","Select","Select",""],["","00254302802","LUBIPROSTONE","8 MCG","60","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":""}]}]}