{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARLA REEVES","gend":1,"add":"4015 S BUFFALO ROAD","city":"LEXINGTON","state":"VA","zip":"24450-9998","dob":"1966-07-17","age":"","mstatus":"","insh":"20030923*01","cliId":"","pno":4435534523,"cno":4435534523,"email":"","ename":"","eno":"","pphy":"SAYRE, WILLIAM MD","ppno":5404639141,"pcpadd":"1 HEALTH CIRCLE,","pcpcity":"LEXINGTON","pcpstate":"VA","pcpzip":"24450-9998","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":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z71.3","Z91.018","R06.2","L50.8","J30.9","R06.02","H10.13","H43.392","R05.","R50.9","R51.9","J02.9","Z11.52","H02.844","R05.9","R10.32","R00.0","K59.00","R11.0","R07.0","Z20.822","Z91.011","E55.9","M25.561","M25.571","L03.213","J44.1","K05.10","J45.40","L50.9","J06.9","D72.829","J44.9","E11.9","E03.9","Z79.890","Z79.84","Z79.899","R94.31","J45.909","B88.0","I50.9","R53.83","R11.2","K43.9","M25.50","T78.1XXA","J47.9","T78.00XA","R21.","R22.1","R06.9","R09.02","V89.2XXA","S51.811A","S40.811A","S40.812A","M25.531","R07.89","Z01.818","R09.81","R10.84","R19.7","H92.01","Z23.","R29.810","K04.7","R09.89","R05.1","K21.9","T50.905A","F43.9","Z91.014","R07.2","J45.21","T45.0X5A","F43.0","Z20.828","R22.32","E28.39","M25.562"],"date":["2021-01-12","2022-11-30","2021-07-15","2022-11-30","2022-11-30","2021-07-15","2022-11-30","2021-03-08","2021-09-01","2022-11-19","2022-11-19","2022-11-19","2021-03-11","2021-11-15","2022-09-27","2022-11-20","2022-11-19","2022-11-19","2022-11-19","2022-11-19","2022-11-19","2022-11-30","2023-07-18","2021-05-19","2021-05-19","2021-09-06","2021-10-18","2021-12-08","2022-11-30","2022-03-24","2022-11-20","2022-11-19","2022-11-30","2023-07-18","2023-07-18","2022-11-19","2022-11-19","2022-11-19","2022-11-19","2021-08-11","2021-08-11","2022-03-31","2022-11-19","2022-03-31","2022-11-19","2022-11-30","2022-11-30","2022-11-30","2021-05-22","2021-05-22","2021-05-22","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2022-11-19","2021-07-10","2022-07-22","2022-11-19","2021-05-08","2021-05-08","2021-12-27","2021-12-27","2021-11-28","2022-01-07","2022-11-20","2022-07-02","2022-07-02","2022-07-02","2022-07-02","2022-07-02","2022-07-02","2022-07-02","2022-07-02","2021-03-11","2023-07-18","2023-07-18","2023-07-18"],"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":[["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","00172572970","FAMOTIDINE","40 MG","90","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","60","Select","Select",""],["","00597008717","ATROVENT HFA","AER 17MCG","13","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","16729045217","LEVOTHYROXIN","TAB 112MCG","30","Select","Select",""],["","51224002206","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","67877056110","METFORMIN","TAB 500MG","60","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","13668008005","MONTELUKAST","CHW 5MG","60","Select","Select",""],["","74312015605","VITAMIN D","3 25 MCG","30","Select","Select",""],["","33342032954","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","16729048601","METHOTREXATE","TAB 2.5MG","16","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","08373982700","OPTICHAMBER","MIS DIA LG","1","Select","Select",""],["","70069013101","TOBRAMYCIN","SOL 0.3% OP","5","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","54629012800","FOLIC ACID","TAB 1000MCG","30","Select","Select",""],["","00069073166","ZYRTEC","TAB 10MG","60","Select","Select",""],["","57237007630","ONDANSETRON","TAB 8MG","30","Select","Select",""],["","00085461001","DULERA","AER 200-5MCG","13","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","17","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","74312015605","D3-1000","CAP 1000UNIT","30","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","14","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","71930005512","APAP\/CODEINE","TAB 300-30MG","8","Select","Select",""],["","51660052605","ALLERGY RELF","TAB 10MG","30","Select","Select",""],["","23155065205","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","55111028050","LEVOFLOXACIN","TAB 500MG","10","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","2","Select","Select",""],["","00173072020","FLOVENT HFA","AER 220MCG","12","Select","Select",""],["","00143211205","DOXYCYCL HYC","TAB 100MG","20","Select","Select",""],["","57237004330","VALACYCLOVIR","TAB 1GM","20","Select","Select",""],["","68180030320","CEFUROXIME","TAB 500MG","20","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","48","Select","Select",""],["","80777027398","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","12547017167","BENADRYL","CRE 2% EX ST","28","Select","Select",""],["","24208039915","IPRATROPIUM","SPR 0.0006","15","Select","Select",""],["","79854009310","VITAMIN D3","CAP 1000UNIT","30","Select","Select",""],["","59651036205","IBUPROFEN","800 MG","30","Select","Select",""],["","68180067711","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","16729048516","HYDROXYCHLOR","TAB 200MG","30","Select","Select",""],["","66993008096","FLUTICAS HFA","AER 220MCG","12","Select","Select",""],["","45802058084","SCOPOLAMINE","DIS 1MG\/3DAY","4","Select","Select",""],["","52959030020","CEFPROZIL","TAB 500MG","20","Select","Select",""],["","66993013697","FLUTIC\/VILAN","INH 200-25","60","Select","Select",""],["","00173088210","BREO ELLIPTA","200-25 MCG","60","Select","Select",""],["","24208039915","IPRATROPIUM BROMIDE","42 MCG","15","Select","Select",""],["","45802091987","CETIRIZINE HCL","10 MG","120","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","13668008005","MONTELUKAST SODIUM","5 MG","60","Select","Select",""],["","68382009605","HYDROXYCHLOROQUINE SULFATE","200 MG","60","Select","Select",""],["","16729045217","LEVOTHYROXINE SODIUM","112 MCG","30","Select","Select",""],["","42385094711","METFORMIN HCL","500 MG","60","Select","Select",""],["","50383070016","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","16729048601","METHOTREXATE TAB","2.5MG","16","Select","Select",""],["","33342032954","TRIAMCINOLON CRE","0.1%","454","Select","Select",""],["","80777027399","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","00115169449","EPINEPHRINE INJ","0.3MG","2","Select","Select",""],["","16729045217","LEVOTHYROXIN TAB","112MCG","30","Select","Select",""],["","12547017167","BENADRYL CRE","2% EX ST","28","Select","Select",""],["","00143211205","DOXYCYCL HYC TAB","100MG","20","Select","Select",""],["","00172572970","FAMOTIDINE TAB","40MG","180","Select","Select",""],["","24208039915","IPRATROPIUM SPR","0.06%","15","Select","Select",""],["","00597008717","ATROVENT HFA AER","17MCG","13","Select","Select",""],["","00173072020","FLOVENT HFA AER","220MCG","12","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","30","Select","Select",""],["","67877056110","METFORMIN TAB","500MG","60","Select","Select",""],["","74312015605","D","3-1000 CAP 1000UNIT","30","Select","Select",""],["","13668008005","MONTELUKAST CHW","5MG","60","Select","Select",""],["","45802091987","CETIRIZINE TAB","10MG","60","Select","Select",""],["","59651036205","IBUPROFEN TAB","800MG","30","Select","Select",""],["","68180067711","OSELTAMIVIR CAP","75MG","10","Select","Select",""],["","16729048516","HYDROXYCHLOR TAB","200MG","30","Select","Select",""],["","45802058084","SCOPOLAMINE DIS","1MG\/3DAY","4","Select","Select",""],["","66993008096","FLUTICAS HFA AER","220MCG","12","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","57237007630","ONDANSETRON TAB","8MG","30","Select","Select",""],["","66993013697","FLUTIC\/VILAN INH","200-25","60","Select","Select",""],["","50383070016","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","42806054701","VITAMIN D CAP","1.25MG","12","Select","Select",""],["","00173088210","BREO ELLIPTA INH","200-25","60","Select","Select",""],["","57237003750","CEFPROZIL TAB","500MG","20","Select","Select",""],["","42806040021","METHYLPRED TAB","4MG","21","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":""}]}]}