{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBORAHA F DUBE","gend":1,"add":"1804 E MAIN ST UNIT 36","city":"RADFORD","state":"VA","zip":"24141-9998","dob":"1964-09-05","age":"","mstatus":"","insh":"20026700*01","cliId":"","pno":7576032450,"cno":7576032450,"email":"","ename":"","eno":"","pphy":"CALL, LINDSAY DO","ppno":5409510352,"pcpadd":"901 PLANTATION RD SUITE 1,","pcpcity":"BLACKSBURG","pcpstate":"VA","pcpzip":"24060-9998","pcpcounty":"","pcpid":"","pcpname":"Carilion Healthcare Corp","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5409517724,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F63.2","F31.9","F31.62","K44.9","K66.0","F41.9","R73.9","E78.5","J01.00","Z86.2","K90.9","R19.7","R05.9","R51.9","F41.1","Z51.81","J32.9","M54.40","G89.29","F13.20","M79.604","M54.17","M79.605","V58.89","R42.","G47.00","R11.0","F33.2","J40.","M54.6","J20.9","L40.0","Z79.899","Z01.818","R53.83","I10.","D50.9","S09.90XA","F31.81","M54.9","M54.41","R41.3","D62.","R55.","R07.2","R06.02","R53.1","F39.","D64.9","R94.31","H04.123","Z01.00","Z20.822","J18.9","J10.1","Z01.419","F41.8","Z90.710","H92.03","J06.9","R05.","L85.3","M46.1","M25.511","J01.80","Z98.84","J45.909","J32.8","M26.609","F45.8"],"date":["2022-11-29","2022-08-09","2022-01-20","2021-12-01","2021-12-01","2022-11-29","2022-02-23","2022-02-23","2022-02-23","2022-02-23","2022-02-23","2022-02-23","2022-03-18","2022-11-29","2022-08-29","2022-08-29","2022-12-05","2022-08-29","2022-08-29","2023-01-31","2022-11-30","2022-11-30","2022-11-30","2021-11-09","2021-11-09","2022-11-29","2021-11-09","2022-01-24","2022-05-24","2021-02-05","2021-07-16","2021-10-11","2021-10-11","2021-11-26","2022-11-29","2022-11-29","2021-08-09","2021-10-14","2022-09-07","2022-04-27","2022-05-24","2021-06-21","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2021-09-24","2021-07-23","2021-11-17","2021-12-07","2021-12-07","2022-09-22","2022-09-22","2022-09-22","2021-09-23","2021-09-23","2021-09-23","2022-03-02","2022-03-02","2021-09-24","2021-09-01","2021-10-22","2021-10-22","2021-10-22","2021-12-01","2021-12-01","2022-03-23","2022-03-23","2022-03-23"],"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":[["","00074055402","HUMIRA PEN","INJ 40\/0.4ML","2","Select","Select",""],["","51672413001","LAMOTRIGINE","TAB 25MG","60","Select","Select",""],["","31722070190","LOSARTAN POT","TAB 50MG","90","Select","Select",""],["","42571016242","AMOX\/K CLAV","TAB 875-125","10","Select","Select",""],["","51991070610","ALPRAZOLAM","TAB 1MG","60","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","13668021630","ARIPIPRAZOLE","TAB 2MG","90","Select","Select",""],["","70436001002","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","43547035411","LISINOPRIL","TAB 20MG","90","Select","Select",""],["","51672421701","DOXEPIN HCL","CAP 10MG","30","Select","Select",""],["","69117001901","ACYCLOVIR","TAB 800MG","8","Select","Select",""],["","62332037931","TEMAZEPAM","CAP 7.5MG","30","Select","Select",""],["","67877019910","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","16729008101","NALTREXONE","TAB 50MG","15","Select","Select",""],["","67877024210","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","8","Select","Select",""],["","57894064011","TREMFYA","INJ 100MG\/ML","1","Select","Select",""],["","43547028211","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","00172392770","DIAZEPAM","TAB 10MG","60","Select","Select",""],["","57237004105","PENICILLN VK","TAB 500MG","30","Select","Select",""],["","42858011830","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00173071820","FLOVENT HFA","AER 44MCG","11","Select","Select",""],["","70069000510","CYANOCOBALAM","INJ 1000MCG","1","Select","Select",""],["","23155019201","BUPROPION","TAB 100MG","30","Select","Select",""],["","08290305269","3ML SYRINGE","MIS 25GX5\/8\"","12","Select","Select",""],["","64380078508","PREDNISONE","TAB 20MG","15","Select","Select",""],["","68462059089","FLUOCIN ACET","OIL SCALP","118","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","76385012350","METHOCARBAM","TAB 500MG","112","Select","Select",""],["","59746012110","MECLIZINE","TAB 25MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","55111064505","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","64980020501","LITHIUM CARB","TAB 300MG ER","60","Select","Select",""],["","00115166003","PROPRANOLOL","TAB 20MG","30","Select","Select",""],["","51224002230","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00023916360","RESTASIS","EMU 0.0005","60","Select","Select",""],["","67877021660","CEFUROXIME","TAB 500MG","20","Select","Select",""],["","10702080806","CYCLOSPORINE","EMU 0.0005","60","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","66993007896","FLUTICAS HFA","AER 44MCG","11","Select","Select",""],["","62135098505","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","16729053308","DODEX","INJ ","1","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00592800100",""," ","1","Select","Select",""],["","70436001002","BUPROPN HCL TAB","150MG XL","30","Select","Select",""],["","16729008101","NALTREXONE TAB","50MG","15","Select","Select",""],["","57894064011","TREMFYA INJ","100MG\/ML","1","Select","Select",""],["","00173071820","FLOVENT HFA AER","44MCG","11","Select","Select",""],["","00143962125","CYANOCOBALAM INJ","1000MCG","1","Select","Select",""],["","16571066101","MECLIZINE TAB","25MG","30","Select","Select",""],["","00603188016","LIDOCAINE PAD","5%","30","Select","Select",""],["","51991070610","ALPRAZOLAM TAB","1MG","60","Select","Select",""],["","43547028211","ESCITALOPRAM TAB","20MG","30","Select","Select",""],["","59267100001","PFIZER VACC INJ COVID-","19","0","Select","Select",""],["","64980020501","LITHIUM CARB TAB","300MG ER","60","Select","Select",""],["","43547035411","LISINOPRIL TAB","20MG","90","Select","Select",""],["","42571016242","AMOX\/K CLAV TAB","875-125","10","Select","Select",""],["","57237007710","ONDANSETRON TAB","4MG ODT","20","Select","Select",""],["","51224002230","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","31722077801","ACYCLOVIR TAB","800MG","90","Select","Select",""],["","00406048410","APAP\/CODEINE TAB","300-30MG","8","Select","Select",""],["","69238207807","PROPRANOLOL TAB","20MG","90","Select","Select",""],["","67877019910","AMLODIPINE TAB","10MG","30","Select","Select",""],["","00023916330","RESTASIS EMU","0.05% OP","60","Select","Select",""],["","21922000909","DICLOFENAC GEL","1%","100","Select","Select",""],["","64380078508","PREDNISONE TAB","20MG","10","Select","Select",""],["","00172392770","DIAZEPAM TAB","10MG","60","Select","Select",""],["","67877021660","CEFUROXIME TAB","500MG","20","Select","Select",""],["","10702080806","CYCLOSPORINE EMU","0.05%","60","Select","Select",""],["","66993007896","FLUTICAS HFA AER","44MCG","11","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","16571040250","CETIRIZINE TAB","10MG","30","Select","Select",""],["","62135098505","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","16729053308","DODEX INJ","","1","Select","Select",""],["","59267030402","PFIZER BIVAL INJ BA","4\/BA5","0","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":""}]}]}