{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROL L NALLICK","gend":1,"add":"250 HUNTINGWOOD LN BARBARA CONTI","city":"FINCASTLE","state":"VA","zip":"24090-9998","dob":"1963-11-06","age":"","mstatus":"","insh":"20039515*01","cliId":"","pno":5404733503,"cno":5404733503,"email":"","ename":"","eno":"","pphy":"STIDHAM, GREGORY MD","ppno":5409660400,"pcpadd":",","pcpcity":"DALEVILLE","pcpstate":"VA","pcpzip":"24083-9998","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":5402245684,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","H40.1132","G40.019","Z96.89","L57.0","L30.9","L65.9","L82.1","L81.4","I78.1","D23.9","D49.2","L73.9","L98.9","H01.001","L82.0","Z01.419","Z78.0","C44.41","D48.5","Z01.818","R56.9","I10.","E78.2","G40.219","S93.401A","K21.9","F33.9","NO DATA"],"date":["2021-12-31","2023-08-14","2022-09-01","2022-03-03","2023-05-04","2023-05-04","2023-05-04","2022-11-28","2022-11-28","2022-11-28","2022-11-28","2022-11-28","2023-02-07","2023-02-07","2022-04-21","2021-10-22","2021-10-06","2021-10-06","2021-02-10","2021-02-10","2021-03-24","2021-04-27","2022-08-05","2022-08-05","2022-08-05","2021-01-26","2021-08-04","2023-09-22","2023-08-14"],"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":[["","29300013001","HYDROCHLOROT CAP","12.5MG","28","Select","Select",""],["","24208046325","LATANOPROST SOL","0.005%","2","Select","Select",""],["","51672413101","LAMOTRIGINE TAB","100MG","56","Select","Select",""],["","24208091055","ERYTHROMYCIN OIN","5MG\/GM","4","Select","Select",""],["","00536123441","ASPIRIN LOW TAB","81MG EC","28","Select","Select",""],["","65862059505","DIVALPROEX TAB","500MG ER","28","Select","Select",""],["","57896020110","PAIN RELIEF TAB","500MG","60","Select","Select",""],["","59267102501","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","50580048810","TYLENOL TAB","500MG\/RR","60","Select","Select",""],["","00904581660","MAPAP TAB","500MG\/RR","60","Select","Select",""],["","00536106210","STOOL SOFTNR CAP","100MG","30","Select","Select",""],["","51672411806","FLUOROURACIL CRE","5%","40","Select","Select",""],["","29300013001","HYDROCHLOROTHIAZIDE","12.5 MG","28","Select","Select",""],["","51672413101","LAMOTRIGINE","100 MG","56","Select","Select",""],["","00536123441","ASPIRIN EC","81 MG","28","Select","Select",""],["","24208046325","LATANOPROST","0.005 %","2.5","Select","Select",""],["","51672411806","FLUOROURACIL","5 %","40","Select","Select",""],["","65862059505","DIVALPROEX SODIUM ER","500 MG","28","Select","Select",""],["","57896020110","PAIN RELIEF","500 MG","60","Select","Select",""],["","00536106210","STOOL SOFTENER","100 MG","30","Select","Select",""],["","29300013001","HYDROCHLOROT","CAP 12.5MG","28","Select","Select",""],["","24208091055","ERYTHROMYCIN","5 MG\/GRAM","3.5","Select","Select",""],["","65862059505","DIVALPROEX","TAB 500MG ER","28","Select","Select",""],["","00536123441","ASPIRIN LOW","TAB 81MG EC","28","Select","Select",""],["","50580048810","TYLENOL","TAB 500MG\/RR","60","Select","Select",""],["","00536106210","STOOL SOFTNR","CAP 100MG","30","Select","Select",""],["","00904581660","MAPAP","TAB 500MG\/RR","60","Select","Select",""],["","59267102501","PFIZER VACC","INJ ADLT RTU","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":""}]}]}