{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ISMAEL N PEREZ","gend":0,"add":"1901 BRAEBURN DR APT 702","city":"SALEM","state":"VA","zip":"24153-9998","dob":"2001-08-16","age":"","mstatus":"","insh":"1765812*01","cliId":"","pno":5402838892,"cno":5402838892,"email":"","ename":"","eno":"","pphy":"BLASKIS, WILLIAM J DO","ppno":5403870441,"pcpadd":"1935 W MAIN ST,","pcpcity":"SALEM","pcpstate":"VA","pcpzip":"24153-9998","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":5403897868,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G40.909","S06.9X9S","N17.9","M62.82","E83.51","N17.0","NO DATA","F17.210","Z91.19","R56.9","I45.10","L02.413","F17.200","G40.89","R00.0","R74.01","F19.10","G40.919","F90.2","R41.82","S00.81XA","R41.0","Z87.820","L02.91","E87.2","E11.9","E87.3","F33.1","F02.81","F43.23","G47.00","F90.9","G40.501","G93.49","G93.89","R73.9","Z20.822","Z91.14","R45.1","F14.90","F17.290","Z78.1","Z53.29","R56.1","R11.10","A41.9","G93.41","R07.9","R77.8","I25.5","R40.4","R45.5","S06.9XAS","R55.","G92.","J69.0","F12.90","R32.","F43.9","G40.509","F14.10","S01.512A","F05.","G40.901","D72.829","G93.40","E87.0","Z99.11","R11.2","B35.3","I49.9","R09.02","R00.1","E87.4","F12.10","I10.","Z79.899","D64.9","R41.89","R41.3","V58.89","R50.9","R91.8","R94.31","R10.84","R19.7","R06.02","R53.83","I51.7","G40.409","G40.911","I45.19","S05.92XA","R61.","R40.0"],"date":["2023-09-13","2022-09-15","2022-09-16","2022-09-15","2021-09-19","2021-09-23","2021-09-22","2022-11-15","2022-03-21","2023-07-23","2023-06-04","2022-05-03","2022-05-03","2022-08-04","2022-08-04","2021-09-23","2021-09-23","2023-07-17","2021-11-06","2022-08-28","2023-06-04","2022-08-28","2023-09-13","2022-05-03","2022-09-15","2021-09-17","2021-09-20","2021-12-13","2022-09-01","2022-09-01","2022-09-01","2022-09-15","2022-09-15","2022-09-15","2022-09-15","2022-09-16","2022-09-15","2022-09-15","2023-07-23","2022-09-15","2022-09-15","2022-09-15","2023-06-04","2022-11-15","2022-11-15","2021-09-17","2021-09-17","2021-09-17","2021-09-22","2021-09-22","2021-11-06","2022-08-04","2023-09-13","2022-11-15","2021-09-16","2021-09-16","2022-11-15","2021-09-16","2021-07-01","2021-11-06","2021-11-06","2021-11-06","2022-08-28","2023-06-04","2022-09-16","2022-09-16","2022-09-16","2022-09-16","2022-11-15","2021-07-15","2021-09-20","2021-09-16","2021-09-16","2021-09-19","2021-09-19","2021-09-19","2023-06-04","2021-09-23","2022-07-28","2022-07-28","2022-07-28","2022-09-15","2022-09-15","2023-06-04","2021-09-19","2021-09-19","2021-09-19","2021-09-19","2021-09-23","2022-08-28","2023-06-04","2023-06-04","2023-06-05","2023-07-23","2023-07-23"],"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":[["","51991029401","OXCARBAZEPIN","TAB 600MG","90","Select","Select",""],["","24658031205","DOXYCYCL HYC","TAB 100MG","20","Select","Select",""],["","59779008001","ATHLETE FOOT","CRE 0.01","15","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","49884030802","CLONAZEP ODT","TAB 0.5MG","10","Select","Select",""],["","72252051002","VALTOCO","10MG\/SPRAY","6","Select","Select",""],["","65862001901","CEPHALEXIN","CAP 500MG","15","Select","Select",""],["","00131247835","VIMPAT","TAB 100MG","60","Select","Select",""],["","68462067960","LACOSAMIDE","TAB 100MG","180","Select","Select",""],["","16571067310","PHENOBARB","TAB 32.4MG","134","Select","Select",""],["","16571066701","PHENOBARBITAL","64.8 MG","180","Select","Select",""],["","51991029401","OXCARBAZEPIN TAB","600MG","90","Select","Select",""],["","57664078586","CLONAZEP ODT TAB","0.5MG","10","Select","Select",""],["","68180012202","CEPHALEXIN CAP","500MG","15","Select","Select",""],["","72252051002","VALTOCO SPR","10MG","2","Select","Select",""],["","00131247835","VIMPAT TAB","100MG","60","Select","Select",""],["","68462067960","LACOSAMIDE TAB","100MG","180","Select","Select",""],["","16571067310","PHENOBARB TAB","32.4MG","134","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":""}]}]}