{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA M WERTZ","gend":1,"add":"400 MOREWOOD RD","city":"HARDY","state":"VA","zip":"24101-9998","dob":"1964-07-09","age":"","mstatus":"","insh":"20040195*01","cliId":"","pno":5402936868,"cno":5402936868,"email":"","ename":"","eno":"","pphy":"OLSEN, CHRISTOPHER DO","ppno":5409618040,"pcpadd":"282 WESTLAKE RD,","pcpcity":"HARDY","pcpstate":"VA","pcpzip":"24101-9998","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":5409619466,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.8","Z79.4","R11.0","M51.37","F41.8","F51.04","M54.12","M54.16","Z79.899","G89.4","Z72.0","M70.60","I25.10","I25.84","NO DATA","K14.0","J04.0","I51.7","J20.9","R05.1","R09.81","Z95.1","I20.8","Z01.810","M41.9","R19.4","R10.84","K76.0","K21.9","Z86.010","M51.16","M25.551","E03.4","I10.","E11.49","F41.1","M62.830","K58.9","E78.5","E11.65","F17.200","N17.9","R25.2","I31.3","R21.","R10.2","F17.210","J30.9","Z91.09","M16.11","F11.20","G95.9","M54.2","R10.13","R06.00","E78.2","E83.42","R79.89","R39.9","Z12.39","R39.15","E11.9","H66.002","J01.90","B96.89","S42.292A","S72.142A","S79.912A","S49.92XA","W10.8XXA","R94.31","W19.XXXA","S42.302A","Z87.891","R91.8","R00.0","I95.9","E66.9","D62.","J44.9","E55.9","Z68.31","V54.13","V54.11","W19.XXXD","E03.9","Z98.890","G89.29","G47.00","R30.0","F41.0","E11.42","E86.9","Z51.89","T07.XXXD","M62.81","R60.0","Z20.822","E11.649","I95.81","S42.202A","K59.00","R60.9","Z01.818","E03.8","Z09.","T07.XXXA","R26.89"],"date":["2023-08-22","2023-08-22","2022-06-28","2022-02-14","2023-04-26","2022-02-14","2022-10-06","2022-10-06","2023-06-16","2023-04-26","2023-04-27","2022-10-06","2023-01-23","2022-12-07","2023-04-26","2022-02-07","2022-02-07","2022-06-02","2022-11-16","2022-11-16","2022-11-16","2022-12-07","2023-01-23","2023-04-17","2021-09-01","2022-09-06","2022-09-06","2022-09-06","2023-04-26","2022-09-06","2023-01-26","2023-01-26","2022-06-28","2023-06-16","2022-06-28","2021-09-03","2021-07-12","2022-03-04","2023-05-09","2023-05-08","2022-03-04","2021-09-03","2021-09-03","2022-06-02","2022-07-07","2022-10-06","2023-04-17","2022-11-15","2022-11-15","2023-03-07","2023-03-07","2021-04-28","2023-04-17","2022-03-04","2022-03-04","2022-06-28","2023-04-27","2022-06-28","2022-10-07","2022-10-07","2021-01-13","2023-04-22","2021-12-05","2021-12-05","2021-12-05","2023-04-19","2023-04-25","2023-04-17","2023-04-17","2023-04-17","2023-04-17","2023-04-25","2023-04-25","2022-07-06","2022-07-06","2023-04-18","2023-04-27","2023-04-27","2023-04-29","2023-04-27","2023-04-27","2023-04-27","2023-05-09","2023-05-09","2023-05-09","2023-05-09","2023-04-22","2023-04-18","2023-04-26","2023-04-22","2023-04-26","2023-04-26","2023-04-26","2023-07-26","2023-07-26","2023-07-26","2023-04-28","2023-04-17","2023-04-17","2023-04-17","2023-04-17","2023-04-22","2023-05-02","2023-04-17","2023-04-26","2023-05-12","2023-05-12","2023-05-10"],"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":[["","43598029490","PREGABALIN","CAP 100MG","90","Select","Select",""],["","59779030603","CVS PURELAX","POW ","510","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","400","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","45","Select","Select",""],["","68180038909","FENOFIBRATE","145 MG","30","Select","Select",""],["","69584009350","BUSPIRONE","TAB 15MG","90","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00603188016","LIDOCAINE","5 %","90","Select","Select",""],["","31604002576","MAGNESIUM","400 MG","180","Select","Select",""],["","50111045001","TRAZODONE","TAB 150MG","135","Select","Select",""],["","00591046010","GLIPIZIDE","5 MG","90","Select","Select",""],["","68382003516","VENLAFAXINE","CAP 75MG ER","90","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","400","Select","Select",""],["","70377003012","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","57599080300","FREESTY LIBR","MIS 2 READER","1","Select","Select",""],["","00832105515","BACLOFEN","20 MG","120","Select","Select",""],["","50458014030","INVOKANA","100 MG","30","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","15","Select","Select",""],["","00074706990","SYNTHROID","150 MCG","90","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","180","Select","Select",""],["","59651000305","OMEPRAZOLE","40 MG","90","Select","Select",""],["","65162019050","NAPROXEN","500 MG","60","Select","Select",""],["","71093011205","GABAPENTIN","800 MG","135","Select","Select",""],["","60505384901","CELECOXIB","CAP 200MG","30","Select","Select",""],["","08290320109","BD PEN NEEDL","MIS 31GX8MM","400","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","43386035801","HYDROCO\/APAP","TAB 10-325MG","150","Select","Select",""],["","00456120330","LINZESS","72 MCG","30","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","60","Select","Select",""],["","69547035302","NARCAN","4 MG","2","Select","Select",""],["","59267100003","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","42858010401","OXYCOD\/APAP","TAB 10-325MG","120","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00054414622","CLOTRIMAZOLE","TRO 10MG","35","Select","Select",""],["","08627001601","DEXCOM G6","MIS TRANSMIT","1","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","10006073038","MAG OXIDE","TAB 400MG","30","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","10702000801","OXYCODONE","TAB 15MG","180","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","Select","Select",""],["","43386031214","GAVILAX","POW ","510","Select","Select",""],["","24208031510","POLYMYXIN B\/","SOL TRIMETHP","10","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","4000","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","400","Select","Select",""],["","10702000801","OXYCODONE HCL","15 MG","180","Select","Select",""],["","70377003012","ATORVASTATIN CALCIUM","80 MG","90","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","10006073038","MAGNESIUM OXIDE","400 MG","30","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","50111045001","TRAZODONE HCL","150 MG","45","Select","Select",""],["","00002879959","HUMALOG KWIKPEN U-","100 100\/ML","15","Select","Select",""],["","69584009350","BUSPIRONE HCL","15 MG","90","Select","Select",""],["","00093220401","METOCLOPRAMIDE HCL","5 MG","60","Select","Select",""],["","53746052101","PROMETHAZINE HCL","25 MG","30","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","30","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","48","Select","Select",""],["","68382003516","VENLAFAXINE HCL ER","75 MG","90","Select","Select",""],["","59779030603","PURELAX","17 G\/DOSE","510","Select","Select",""],["","80681007600","MULTIVITAMIN WITH MINERALS","15 MG","30","Select","Select",""],["","57896062101","THERA-TABS M","27MG-400","30","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","10","Select","Select",""],["","00173086910","ANORO ELLIPTA","62.5-25MCG","60","Select","Select",""],["","08290320119","ULTRA-FINE MINI PEN NEEDLE","31 GX3\/16\"","30","Select","Select",""],["","67618010760","SLOW-MAG","71.5 MG","120","Select","Select",""],["","49502039475","INSULIN GLARGINE-YFGN","100\/ML (3)","15","Select","Select",""],["","50428029464","SENNA PLUS","8.6MG-50MG","60","Select","Select",""],["","00597015230","JARDIANCE","10 MG","30","Select","Select",""],["","45802048678","DOCUSATE SODIUM","100 MG","30","Select","Select",""],["","00574006945","GLUTOSE-","45 40 %","112.5","Select","Select",""],["","59779058401","STOOL SOFTENER-STIMULANT LAX","8.6MG-50MG","60","Select","Select",""],["","00536589588","NICOTINE PATCH","14MG\/24HR","28","Select","Select",""],["","68462010530","ONDANSETRON TAB","4MG","15","Select","Select",""],["","69584009350","BUSPIRONE TAB","15MG","90","Select","Select",""],["","00591046010","GLIPIZIDE TAB","5MG","90","Select","Select",""],["","50458014030","INVOKANA TAB","100MG","30","Select","Select",""],["","71093011205","GABAPENTIN TAB","800MG","135","Select","Select",""],["","00832105515","BACLOFEN TAB","20MG","90","Select","Select",""],["","69097052444","DICLOFENAC GEL","1%","400","Select","Select",""],["","00074706990","SYNTHROID TAB","150MCG","90","Select","Select",""],["","00002879959","HUMALOG KWIK INJ","100\/ML","15","Select","Select",""],["","68180038909","FENOFIBRATE TAB","145MG","90","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","00603188016","LIDOCAINE PAD","5%","90","Select","Select",""],["","42858010401","OXYCOD\/APAP TAB","10-325MG","150","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","45","Select","Select",""],["","08290320109","BD PEN NEEDL MIS","31GX8MM","400","Select","Select",""],["","65162019050","NAPROXEN TAB","500MG","60","Select","Select",""],["","08627001601","DEXCOM G","6 MIS TRANSMIT","1","Select","Select",""],["","00054414622","CLOTRIMAZOLE TRO","10MG","35","Select","Select",""],["","68180016011","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","68382003516","VENLAFAXINE CAP","75MG ER","90","Select","Select",""],["","50111045001","TRAZODONE TAB","150MG","135","Select","Select",""],["","68180072003","AMLODIPINE TAB","5MG","180","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","59651000305","OMEPRAZOLE CAP","40MG","90","Select","Select",""],["","00093221001","SUCRALFATE TAB","1GM","120","Select","Select",""],["","00093220401","METOCLOPRAM TAB","5MG","60","Select","Select",""],["","68180098003","LISINOPRIL TAB","10MG","90","Select","Select",""],["","53746052101","PROMETHAZINE TAB","25MG","30","Select","Select",""],["","70377003012","ATORVASTATIN TAB","80MG","90","Select","Select",""],["","11917017677","MAGNESIUM TAB","400MG","30","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","400","Select","Select",""],["","10006073038","MAG OXIDE TAB","400MG","30","Select","Select",""],["","59779030603","CVS PURELAX POW","","510","Select","Select",""],["","31604002576","MAGNESIUM CAP","400MG","180","Select","Select",""],["","00456120330","LINZESS CAP","72MCG","30","Select","Select",""],["","00378064205","PREDNISONE TAB","20MG","10","Select","Select",""],["","10702000801","OXYCODONE TAB","15MG","180","Select","Select",""],["","47781030301","NITROFURANTN CAP","100MG","10","Select","Select",""],["","75826011510","PHENAZOPYRID TAB","200MG","6","Select","Select",""],["","64380076921","PEG-","3350\/KCL SOL \/SODIUM","4000","Select","Select",""],["","24208031510","POLYMYXIN B\/ SOL TRIMETHP","","10","Select","Select",""],["","43386031214","GAVILAX POW","","510","Select","Select",""],["","64980056210","FUROSEMIDE","20 MG","30","Select","Select",""],["","53885004401","ONETOUCH VERIO FLEX METER","","1","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":""}]}]}