{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DARRIN E SWIHART","gend":0,"add":"544 TRIPPLE CREEK RD APT 1","city":"ROCKY MOUNT","state":"VA","zip":"24151-9998","dob":"1965-06-29","age":"","mstatus":"","insh":"20035860*01","cliId":"","pno":5404933622,"cno":5404933622,"email":"","ename":"","eno":"","pphy":"THORNTON, ALLISON DO","ppno":5404844800,"pcpadd":"390 SOUTH MAIN STREET,","pcpcity":"ROCKY MOUNT","pcpstate":"VA","pcpzip":"24151-9998","pcpcounty":"","pcpid":"","pcpname":"Carilion Giles Community Hospital","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5409215606,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R19.5","R52.","G44.89","L02.31","M47.817","M54.16","M51.37","M25.512","G89.29","Z79.899","M25.612","M62.81","R07.89","R06.02","M79.662","D72.829","E03.9","I10.","E11.40","Z20.822","E78.5","J45.909","Z86.16","Z79.82","N13.5","G47.30","U07.1","E11.9","E66.01","M54.9","Z68.42","Z79.84","G47.33","R26.81","M47.816","R06.2","NO DATA","N20.0","N39.0","N39.41","N52.9","R07.9","M47.26","V58.89","A41.9","N20.1","E27.8","I20.0","R51.9","R09.81","Z20.828","R34.","N10.","N13.2","E89.0","F41.0","K21.9","N40.0","R09.02","N12.","R11.2","D72.825","N40.1","R35.1","N23.","R30.0","F41.9","R42.","R03.1","F41.1","R73.03","Z68.43","N13.8","S09.90XA","M54.2","V89.2XXA","I95.2","M51.36","V89.2XXD","R10.9","Z01.818","I45.10","R94.31","M54.42","I95.9","Z93.6","M54.17","S16.1XXA","S39.012A","S90.31XA","G44.319","Z28.310","J06.9","R05.9","D35.01","Z01.810","R00.1","G43.909","R05.","R11.0","R50.9","R35.0","R19.7","R21.","Z11.52","R53.83","R53.1","M75.102","R10.32","Z79.891","Z11.59","G56.03","Z11.4","E87.6","K62.5","K60.2","K64.4","E78.00"],"date":["2021-03-15","2021-03-15","2021-03-15","2021-03-15","2023-07-27","2023-07-27","2023-03-09","2023-07-27","2023-07-19","2023-07-27","2021-08-11","2021-08-11","2021-12-31","2021-12-31","2021-12-31","2021-12-31","2022-08-14","2023-07-19","2022-08-14","2021-12-31","2022-08-14","2022-08-14","2021-12-31","2023-08-25","2022-07-29","2022-09-01","2022-09-01","2023-07-19","2023-07-19","2022-07-30","2022-08-26","2023-07-15","2023-06-09","2023-03-09","2023-08-25","2023-03-09","2023-07-27","2022-09-01","2022-07-29","2021-10-07","2021-10-07","2021-12-31","2022-06-21","2022-06-21","2022-07-29","2022-08-26","2023-03-16","2021-09-30","2021-09-30","2021-09-30","2021-12-31","2022-07-29","2022-09-01","2022-08-08","2022-07-29","2022-07-29","2022-07-29","2022-07-29","2022-07-29","2022-08-05","2022-07-29","2022-07-29","2022-08-26","2022-08-09","2022-08-14","2022-08-14","2023-08-25","2021-12-31","2021-02-01","2021-06-24","2021-11-19","2021-11-19","2022-09-01","2021-12-15","2023-07-19","2021-12-15","2022-02-01","2022-03-07","2022-03-07","2022-08-14","2022-03-27","2023-03-16","2023-03-16","2022-05-05","2022-05-05","2022-08-08","2022-12-19","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2022-07-29","2022-12-07","2022-12-07","2023-03-16","2023-03-16","2023-03-16","2021-02-01","2021-08-27","2021-02-01","2021-02-01","2021-04-24","2022-03-21","2021-04-24","2021-08-27","2021-12-31","2021-12-31","2022-03-15","2022-07-29","2023-04-06","2023-07-19","2023-07-19","2023-07-19","2023-07-19","2023-07-15","2023-07-15","2023-07-15","2023-07-15"],"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":[["","70377000315","SIMVASTATIN","20 MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE","40 MG","90","Select","Select",""],["","69097012303","TOPIRAMATE","50 MG","180","Select","Select",""],["","62037060090","CARTIA XT","CAP 300\/24HR","15","Select","Select",""],["","68180097903","LISINOPRIL","TAB 40MG","90","Select","Select",""],["","00527169501","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","68382004110","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","68382013210","TAMSULOSIN","CAP 0.4MG","180","Select","Select",""],["","00536100901","FERROUS SULF","TAB 325MG","60","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","60","Select","Select",""],["","00143211205","DOXYCYCL HYC","TAB 100MG","20","Select","Select",""],["","00406012501","HYDROCO\/APAP","TAB 10-325MG","21","Select","Select",""],["","69097094312","GABAPENTIN","300 MG","30","Select","Select",""],["","68462057565","HC VALERATE","CRE 0.002","15","Select","Select",""],["","00904759180","FEROSUL","325(65) MG","60","Select","Select",""],["","31722095801","BENZONATATE","CAP 200MG","30","Select","Select",""],["","00603188016","LIDOCAINE","5 %","30","Select","Select",""],["","00469260230","MYRBETRIQ","TAB 50MG","30","Select","Select",""],["","00536116361","MUCUS RELIEF","TAB 600MG ER","30","Select","Select",""],["","55111018010","TIZANIDINE","TAB 4MG","5","Select","Select",""],["","65862000899","METFORMIN","TAB 500MG","60","Select","Select",""],["","50742025190","DILTIAZEM","24HR ER (CD) 300 MG","90","Select","Select",""],["","00832003810","OXYBUTYNIN","TAB 5MG","90","Select","Select",""],["","63824000815","MUCINEX","TAB 600MG ER","30","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","20","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","6","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","10","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","16729009015","FINASTERIDE","TAB 5MG","30","Select","Select",""],["","49281042250","FLUZONE QUAD","INJ 2022-23","0","Select","Select",""],["","42858000101","OXYCODONE HCL","5 MG","10","Select","Select",""],["","76385012350","METHOCARBAMOL","500 MG","60","Select","Select",""],["","00536100901","FERROUS SULFATE","325(65) MG","60","Select","Select",""],["","53746011001","HYDROCODONE-ACETAMINOPHEN","10MG-325MG","30","Select","Select",""],["","57237001401","TAMSULOSIN HCL","0.4 MG","180","Select","Select",""],["","67877056110","METFORMIN HCL","500 MG","180","Select","Select",""],["","00832003810","OXYBUTYNIN TAB","5MG","90","Select","Select",""],["","68382014005","TOPIRAMATE TAB","100MG","60","Select","Select",""],["","62756013805","GABAPENTIN CAP","300MG","30","Select","Select",""],["","65862000899","METFORMIN TAB","500MG","60","Select","Select",""],["","68180098103","LISINOPRIL TAB","20MG","30","Select","Select",""],["","00904759180","FEROSUL TAB","325MG","60","Select","Select",""],["","55111064505","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","68382013210","TAMSULOSIN CAP","0.4MG","180","Select","Select",""],["","70010075401","METHOCARBAM TAB","500MG","60","Select","Select",""],["","68180047903","SIMVASTATIN TAB","20MG","90","Select","Select",""],["","00406012501","HYDROCO\/APAP TAB","10-325MG","21","Select","Select",""],["","24979002907","DILTIAZEM CAP","300MG ER","90","Select","Select",""],["","00591352530","LIDOCAINE PAD","5%","30","Select","Select",""],["","00406055201","OXYCODONE TAB","5MG","15","Select","Select",""],["","67877054360","CEFDINIR CAP","300MG","10","Select","Select",""],["","16729009015","FINASTERIDE TAB","5MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN TAB","500MG","6","Select","Select",""],["","00116200116","CHLORHEX GLU SOL","0.12%","473","Select","Select",""],["","31722095801","BENZONATATE CAP","200MG","30","Select","Select",""],["","49281042250","FLUZONE QUAD INJ","2022-23","0","Select","Select",""],["","00573284093","PREPARATION H","0.25%-50%","26","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":""}]}]}