{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTOPHER  J KILBOURNE","gend":0,"add":"3617 BUCKNER ROAD SW","city":"ROANOKE","state":"VA","zip":"24015-9998","dob":"1961-12-17","age":"","mstatus":"","insh":"20059499*01","cliId":"","pno":5405536702,"cno":5405536702,"email":"","ename":"","eno":"","pphy":"KELLAM, STEPHEN MD","ppno":5407720555,"pcpadd":"3369 COLONIAL AVE,","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":"24018-9998","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":5407721360,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","J01.00","B20.","Z79.899","I50.22","I48.92","E03.9","B18.2","NO DATA","R00.1","I44.5","R94.31","E87.6","I27.20","H25.13","H52.4","H35.373","H43.812","H43.391","E55.9","N52.9","R45.84","M25.562","R06.09","I42.9","F90.9","M25.50","S61.012A","J01.80","R09.81","R05.","J02.9","R19.7","R51.9","Z20.822","Z20.828","F41.1","Z23.","I08.1","I34.0","I51.7"],"date":["2023-05-25","2023-01-25","2023-06-06","2022-12-05","2022-12-15","2022-06-14","2022-06-14","2022-06-14","2022-12-15","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-12-14","2022-06-14","2021-12-14","2022-12-02","2022-12-15","2022-12-15","2022-12-15","2022-12-15","2021-04-25","2022-10-31","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2022-05-13","2022-05-13","2022-12-15","2022-12-15","2022-12-15"],"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":[["","00245531990","KLOR-CON M20","TAB 20MEQ ER","28","Select","Select",""],["","53489014305","SPIRONOLACT","TAB 25MG","28","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","28","Select","Select",""],["","00527221537","METOLAZONE","TAB 2.5MG","8","Select","Select",""],["","68382022714","AMIODARONE","TAB 200MG","28","Select","Select",""],["","00054007725","TORSEMIDE","20 MG","56","Select","Select",""],["","00003089421","ELIQUIS","5 MG","56","Select","Select",""],["","63646001004","KETOCONAZOLE","2 %","120","Select","Select",""],["","16714085301","METOPROL SUC","TAB 50MG ER","84","Select","Select",""],["","00536100836","ASPIRIN","CHW 81MG","30","Select","Select",""],["","62037099901","POT CL MICRO","TAB 20MEQ ER","28","Select","Select",""],["","68382039801","POT CHLORIDE","TAB 20MEQ ER","28","Select","Select",""],["","00378181577","LEVOTHYROXIN","TAB 150MCG","28","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","00093534356","SILDENAFIL","TAB 100MG","8","Select","Select",""],["","42806066301","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","31722077701","ACYCLOVIR","TAB 400MG","15","Select","Select",""],["","63304092401","GUANFACINE","TAB 1MG ER","90","Select","Select",""],["","42806054701","VITAMIN D","CAP 1.25MG","8","Select","Select",""],["","51224002218","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","58160082311","SHINGRIX","50 MCG\/0.5","1","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","68382022714","AMIODARONE HCL","200 MG","28","Select","Select",""],["","53489014305","SPIRONOLACTONE","25 MG","28","Select","Select",""],["","64380074206","BUSPIRONE HCL","10 MG","56","Select","Select",""],["","00378181577","LEVOTHYROXINE SODIUM","150 MCG","28","Select","Select",""],["","00245531990","KLOR-CON M","20 20 MEQ","28","Select","Select",""],["","60505392701","GUANFACINE HCL ER","1 MG","30","Select","Select",""],["","16714085301","METOPROLOL SUCCINATE","50 MG","84","Select","Select",""],["","00168009930","KETOCONAZOLE CRE","2%","30","Select","Select",""],["","63646001004","KETOCONAZOLE SHA","2%","120","Select","Select",""],["","16729045515","LEVOTHYROXIN TAB","150MCG","28","Select","Select",""],["","16714085301","METOPROL SUC TAB","50MG ER","84","Select","Select",""],["","68382022714","AMIODARONE TAB","200MG","28","Select","Select",""],["","00003089421","ELIQUIS TAB","5MG","56","Select","Select",""],["","62037099901","POT CL MICRO TAB","20MEQ ER","28","Select","Select",""],["","53489014305","SPIRONOLACT TAB","25MG","28","Select","Select",""],["","00054007725","TORSEMIDE TAB","20MG","56","Select","Select",""],["","61958250101","BIKTARVY TAB","","28","Select","Select",""],["","63304092401","GUANFACINE TAB","1MG ER","30","Select","Select",""],["","42806066301","BUSPIRONE TAB","10MG","60","Select","Select",""],["","31722077705","ACYCLOVIR TAB","400MG","15","Select","Select",""],["","42806054701","VITAMIN D CAP","1.25MG","8","Select","Select",""],["","51224002218","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","16571020150","DICLOFENAC TAB","75MG DR","60","Select","Select",""],["","59267030402","PFIZER BIVAL INJ BA","4\/BA5","0","Select","Select",""],["","58160082311","SHINGRIX INJ","50\/0.5ML","1","Select","Select",""],["","60219175303","SILDENAFIL CITRATE","100 MG","4","Select","Select",""],["","00069422030","VIAGRA","100 MG","4","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":""}]}]}