{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON F MASON","gend":1,"add":"6419 GARRETT LN","city":"ROANOKE","state":"VA","zip":"24019-9998","dob":"1974-12-04","age":"","mstatus":"","insh":"1814099*01","cliId":"","pno":5405631107,"cno":5405631107,"email":"","ename":"","eno":"","pphy":"BRADY, DON I MD","ppno":5407257800,"pcpadd":"SUITE 2 3707 BRAMBLETON AVE SW","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":"24018-9998","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":5409896752,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K62.82","N87.0","N64.4","N60.11","N60.12","R04.2","G43.009","I05.9","R94.31","Z01.818","R00.0","M81.0","J47.9","R61.","R13.10","I73.00","K21.9","D75.1","Z86.16","Z87.01","G43.019","R05.","NO DATA","M25.50","R06.02","R63.4","Z79.899","R53.83","J32.0","J43.2","G43.709","A63.0","R26.2","M25.561","M25.661","M62.81","J45.21","M81.8","M85.80","Z87.310","M85.89","R05.9","M22.41","I08.1","Z01.419","R87.612","Z87.81","S76.111A","J06.9","J01.90","K62.89","K64.9","J45.31","K08.89","R06.00","M79.7","R13.13","G56.42","F17.210","Z12.39","G90.521","M25.861","Z87.39","J32.9","J40.","Z01.810","N87.9","R00.1","D84.9","J44.9","J30.1","Z87.09","J31.0","Z91.018"],"date":["2022-04-19","2022-01-04","2022-02-24","2022-06-17","2022-06-17","2022-04-13","2022-04-29","2022-08-29","2022-07-14","2022-07-14","2022-07-14","2023-04-03","2023-05-09","2022-11-15","2023-02-15","2022-11-15","2023-05-09","2022-11-15","2022-11-15","2023-05-09","2023-02-09","2021-09-24","2021-11-03","2021-09-24","2023-04-03","2021-09-24","2021-09-24","2022-05-04","2022-03-02","2022-07-06","2023-05-11","2022-08-25","2022-09-07","2022-09-07","2022-09-07","2022-09-07","2021-09-14","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2022-04-07","2022-09-19","2022-08-29","2021-11-03","2021-11-03","2021-12-14","2022-10-17","2023-02-10","2023-02-10","2021-04-02","2021-04-09","2021-12-03","2021-05-17","2022-07-06","2021-12-03","2023-05-09","2021-11-09","2021-11-09","2022-06-17","2022-12-02","2022-12-02","2021-12-14","2022-01-27","2022-01-27","2022-05-19","2022-05-19","2022-05-19","2023-03-30","2023-05-09","2023-04-21","2023-05-09","2023-05-09","2023-05-09"],"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":[["","57237010601","DIVALPROEX","TAB 125MG DR","180","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","69097094312","GABAPENTIN","300 MG","90","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","28","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00173071920","FLOVENT HFA","AER 110MCG","36","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","14","Select","Select",""],["","68180016011","AZITHROMYCIN","250 MG","6","Select","Select",""],["","67877026218","RIZATRIPTAN","TAB 10MG","9","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","70539000102","TYMLOS","INJ ","2","Select","Select",""],["","08290320119","BD PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","70710122600","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","68462053670","IMIQUIMOD","CRE 0.05","20","Select","Select",""],["","23155005519","NARATRIPTAN","TAB 2.5MG","9","Select","Select",""],["","11845015569","FLAX SEEDS","POW ","1020","Select","Select",""],["","49348089610","SM ALCOHOL","PAD PREP","100","Select","Select",""],["","66993007996","FLUTICAS HFA","AER 110MCG","36","Select","Select",""],["","00378698501","SOD CHLORIDE","NEB 0.009","300","Select","Select",""],["","72618300002","NURTEC","TAB 75MG ODT","8","Select","Select",""],["","47335075649","IPRATROPIUM\/","SOL ALBUTER","180","Select","Select",""],["","00378698501","SODIUM CHLORIDE","0.9 %","300","Select","Select",""],["","70710122600","AMITRIPTYLINE HCL","25 MG","90","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER","18 MCG","30","Select","Select",""],["","65862032904","ALENDRONATE SODIUM","70 MG","12","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","72618300002","NURTEC ODT","75 MG","8","Select","Select",""],["","00006483703","PNEUMOVAX","23 25MCG\/0.5","0.5","Select","Select",""],["","00378967130","IPRATROPIUM-ALBUTEROL","0.5-3MG\/3","180","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","45802010901","TRIAMCINOLONE ACETONIDE","55 MCG","16.9","Select","Select",""],["","65862086001","FAMOTIDINE","40 MG","90","Select","Select",""],["","00093005805","TRAMADOL HCL","50 MG","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":""}]}]}