{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TYLER M BROOKENS","gend":0,"add":"5723 ARCTURUS DR","city":"ROANOKE","state":"VA","zip":"24018-9998","dob":"1994-11-02","age":"","mstatus":"","insh":"20050406*01","cliId":"","pno":9252370975,"cno":9252370975,"email":"","ename":"","eno":"","pphy":"GLONTZ, GARY E MD","ppno":5404442010,"pcpadd":"2155 APPERSON DRIVE,","pcpcity":"SALEM","pcpstate":"VA","pcpzip":"24153-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5404442019,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K86.1","K80.20","F10.10","E11.9","Z20.822","F10.239","E10.10","E10.9","F32.9","F17.290","E10.65","F10.20","K85.90","R41.0","T50.901A","Z74.3","R10.9","Z20.828","R65.10","E87.1","R74.01","Z23.","Z87.19","E78.2","Z72.0","F41.8","F41.9","Z71.41","R06.02","M54.9","R10.11","K85.20","E11.00","R19.7","R11.0","R10.13","NO DATA","R00.0","Z79.4","I95.9","F10.129","E86.0","F10.120","R07.9","N17.9","F17.210","Z90.49","Z91.19","E10.69","F19.10","G89.29","R41.82","R73.9","K85.91","K86.0","K76.0","Z59.00","K59.00","E11.65","E09.69","K70.10","F10.920","R21.","E10.649","Z53.21","F33.1","F17.229","E11.43","E11.649","K31.84","Z79.84","E87.6","F15.10","E08.9","Z79.899","Z78.9"],"date":["2022-07-14","2021-05-10","2022-08-11","2021-05-10","2022-08-17","2022-07-27","2022-05-05","2022-07-19","2022-07-27","2022-08-17","2022-07-20","2022-08-09","2022-07-12","2022-07-14","2022-07-14","2022-07-21","2022-07-21","2022-07-27","2021-05-08","2021-05-08","2021-05-08","2021-06-19","2022-04-27","2022-04-27","2022-07-22","2022-07-17","2022-07-27","2022-07-27","2021-05-08","2021-05-08","2022-07-01","2022-07-13","2022-07-12","2022-08-17","2022-07-12","2022-08-11","2022-08-17","2022-07-14","2022-07-20","2022-07-20","2022-08-11","2022-07-20","2022-08-11","2022-07-21","2022-05-05","2022-07-02","2022-07-02","2022-05-04","2022-07-12","2022-07-12","2022-07-12","2022-07-14","2022-07-14","2022-07-14","2022-07-19","2022-07-19","2022-07-19","2021-02-14","2021-03-27","2022-07-02","2022-07-03","2022-07-20","2022-08-17","2022-08-17","2022-08-17","2021-02-24","2021-02-24","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2021-05-08","2022-04-28","2022-07-02","2022-07-02","2022-07-02"],"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":[["","00088221905","LANTUS SOLOS","INJ 100\/ML","3","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","10","Select","Select",""],["","00002822259","INSULIN LISP","INJ 100\/ML","30","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","3","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","16729021716","SERTRALINE","TAB 100MG","30","Select","Select",""],["","08627009111","DEXCOM G6","MIS RECEIVER","1","Select","Select",""],["","10135013201","THIAMINE HCL","TAB 100MG","30","Select","Select",""],["","72065012112","GVOKE HYPO 2","INJ 1MG\/.2ML","1","Select","Select",""],["","62135021010","FOLIC ACID","TAB 1MG","30","Select","Select",""],["","00536110788","NICOTINE TD","DIS 14MG\/24H","14","Select","Select",""],["","63323059303","GLUCAGON","INJ 1MG","1","Select","Select",""],["","00002821501","HUMULIN R","INJ U-100","10","Select","Select",""],["","71093011205","GABAPENTIN","TAB 800MG","90","Select","Select",""],["","38485012041","MULTIVITAMIN","CAP ","30","Select","Select",""],["","08290320749","BD PEN NEEDL","MIS 32GX6MM","100","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","90","Select","Select",""],["","47781060730","DISULFIRAM","TAB 250MG","30","Select","Select",""],["","54629005701","VITAMIN B-1","TAB 100MG","30","Select","Select",""],["","00185067405","HYDROXYZ PAM","CAP 25MG","30","Select","Select",""],["","08317236132","PEN NEEDLES","MIS 32GX6MM","100","Select","Select",""],["","00406117001","NALTREXONE","TAB 50MG","15","Select","Select",""],["","70677003101","SM NICOTINE","DIS 14MG\/24H","14","Select","Select",""],["","57599000200","FREESTYLE","MIS READER","1","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","12","Select","Select",""],["","50111045001","TRAZODONE","TAB 150MG","15","Select","Select",""],["","16729020216","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","00378110101","PRAZOSIN HCL","CAP 1MG","30","Select","Select",""],["","53885014301","ONETOUCH","MIS LANCETS","200","Select","Select",""],["","65757030001","VIVITROL","INJ 380MG","1","Select","Select",""],["","00088222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","15482023632",""," ","100","Select","Select",""],["","00002771227","HUMALOG KWIKPEN U-","200 200\/ML (3)","6","Select","Select",""],["","80777027399","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","00002879959","HUMALOG KWIK INJ","100\/ML","15","Select","Select",""],["","00002822259","INSULIN LISP INJ","100\/ML","30","Select","Select",""],["","10135013201","THIAMINE HCL TAB","100MG","30","Select","Select",""],["","16729021616","SERTRALINE TAB","50MG","44","Select","Select",""],["","72065012112","GVOKE HYPO","2 INJ 1MG\/.2ML","1","Select","Select",""],["","08627009111","DEXCOM G","6 MIS RECEIVER","1","Select","Select",""],["","00228212750","CLONIDINE TAB","0.1MG","90","Select","Select",""],["","00228263711","GABAPENTIN TAB","800MG","90","Select","Select",""],["","63323059303","GLUCAGON INJ","1MG","1","Select","Select",""],["","38485012041","MULTIVITAMIN CAP","","30","Select","Select",""],["","00002821501","HUMULIN R INJ U-","100","10","Select","Select",""],["","69315012710","FOLIC ACID TAB","1000MCG","30","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","3","Select","Select",""],["","00536589588","NICOTINE TD DIS","14MG\/24H","30","Select","Select",""],["","50111045001","TRAZODONE TAB","150MG","15","Select","Select",""],["","08290320749","BD PEN NEEDL MIS","32GX6MM","100","Select","Select",""],["","57599000200","FREESTYLE MIS READER","","1","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","","2","Select","Select",""],["","08317236132","PEN NEEDLES MIS","32GX6MM","100","Select","Select",""],["","00088222033","LANTUS INJ","100\/ML","10","Select","Select",""],["","70677003101","SM NICOTINE DIS","14MG\/24H","14","Select","Select",""],["","47781060730","DISULFIRAM TAB","250MG","30","Select","Select",""],["","00185067405","HYDROXYZ PAM CAP","25MG","30","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","12","Select","Select",""],["","65757030001","VIVITROL INJ","380MG","1","Select","Select",""],["","00406117001","NALTREXONE TAB","50MG","15","Select","Select",""],["","57896085101","VITAMIN B-","1 TAB 100MG","30","Select","Select",""],["","53885014301","ONETOUCH MIS LANCETS","","200","Select","Select",""],["","16729020216","BUSPIRONE TAB","10MG","60","Select","Select",""],["","00378110101","PRAZOSIN HCL CAP","1MG","30","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":""}]}]}