{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERRY SINE","gend":0,"add":"808 MARSHALL AVE SW APT B","city":"ROANOKE","state":"VA","zip":"24016-9998","dob":"1962-08-12","age":"","mstatus":"","insh":"20066461*01","cliId":"","pno":5402043084,"cno":5402043084,"email":"","ename":"","eno":"","pphy":"WANI, LUBNA B MD","ppno":5402245170,"pcpadd":"3 RIVERSIDE CIR,","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":"24016-9998","pcpcounty":"","pcpid":"","pcpname":"Carilion Medical Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5402245170,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I25.5","I25.10","I25.2","Z95.811","Z79.02","Z79.899","F17.210","I51.9","E11.9","I45.10","R94.31","I31.4","I50.23","I95.89","E11.59","I31.3","I11.0","I49.5","E78.5","B19.20","E78.00","E78.1","F41.9","F14.10","I47.1","F17.200","F33.1","I47.2","I25.118","Z95.810","Z79.01","I48.91","I10.","I50.9","E78.2","R06.02","I50.22","F14.90","I51.7","I48.0","NO DATA","Z79.82","R10.9","R11.2","Z20.822","I49.9","Z98.61","F19.10","I25.82","I21.4","I42.0","I49.3","R69.","I08.0","I51.89","I42.9","Z95.0","I21.09","E83.42","E87.6","K04.7","K05.6","I73.9","I44.7","I05.8","R00.1","K21.9","R07.9","Z86.79","F19.90","Z45.02","I49.01","R57.0","B18.2","Z91.19","J81.0","R09.89","R07.2","R77.8","R05.","J34.89","G47.00","Z01.818","K76.9","R94.30","R10.84","R53.83","R42.","R53.1","Z95.5","Z86.16","I50.21","I25.84","Z87.891","E11.65","F17.290","G62.9","Z88.0","F41.1","Z91.14","R07.89","I45.4","R00.2","I50.42","R88.8","I20.9","I25.110","T82.855A","Z72.0"],"date":["2023-05-23","2022-08-08","2022-08-07","2021-05-26","2021-05-26","2022-05-09","2022-08-07","2021-09-04","2023-05-23","2021-09-03","2022-05-09","2021-09-06","2021-09-05","2021-09-04","2021-09-04","2021-09-10","2022-08-07","2021-09-04","2023-05-23","2022-05-09","2021-09-04","2021-09-04","2021-10-28","2023-05-23","2021-09-04","2022-08-08","2022-02-24","2022-08-07","2023-05-16","2023-05-23","2022-05-18","2022-08-08","2023-05-23","2022-08-08","2023-05-16","2021-07-07","2023-05-16","2022-02-24","2022-05-09","2023-05-16","2023-05-16","2021-10-28","2022-07-20","2022-07-20","2022-08-07","2022-08-08","2022-08-08","2022-08-08","2023-05-23","2021-08-30","2021-08-17","2021-09-07","2021-09-15","2022-08-10","2022-08-10","2022-08-10","2022-08-10","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-09","2021-03-08","2021-05-05","2021-07-23","2021-07-23","2021-09-05","2022-05-09","2022-05-09","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-24","2021-08-29","2021-09-10","2021-09-10","2022-07-20","2022-07-20","2022-07-20","2022-07-20","2022-07-20","2022-07-20","2021-03-08","2021-03-09","2021-03-09","2022-08-07","2022-08-07","2022-08-07","2022-08-07","2022-02-24","2022-02-24","2021-09-04","2021-09-05","2022-02-15","2023-05-16","2022-09-23","2023-05-16","2023-05-23","2023-05-23","2023-05-23"],"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":[["","00536589488","NICOTINE TD","DIS 7MG\/24HR","7","Select","Select",""],["","49035056317","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","68645058459","METFORMIN","TAB 1000MG","60","Select","Select",""],["","00186077760","BRILINTA","90 MG","60","Select","Select",""],["","00078065920","ENTRESTO","24 MG-26MG","60","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","65862020199","LOSARTAN POT","TAB 25MG","15","Select","Select",""],["","16729022501","SPIRONOLACT","TAB 25MG","15","Select","Select",""],["","49035019602","EQ NICOTINE","DIS 7MG\/24HR","7","Select","Select",""],["","65862014305","CARVEDILOL","TAB 6.25MG","60","Select","Select",""],["","43547040211","FUROSEMIDE","40 MG","30","Select","Select",""],["","00904404073","ASPIRIN","CHW 81MG","30","Select","Select",""],["","00310621030","FARXIGA","10 MG","30","Select","Select",""],["","13107000130","MIRTAZAPINE","TAB 7.5MG","30","Select","Select",""],["","72205000530","ROSUVASTATIN","TAB 40MG","30","Select","Select",""],["","70700015010","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","62332025118","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00254200801","COLCHICINE","TAB 0.6MG","60","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","68382056410","METOPROL SUC","TAB 25MG ER","180","Select","Select",""],["","00006011231","JANUVIA","50 MG","30","Select","Select",""],["","16714008210","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","72888006130","AMIODARONE","TAB 400MG","28","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","68382056410","METOPROLOL SUCCINATE","25 MG","180","Select","Select",""],["","27241009903","DULOXETINE HCL","60 MG","30","Select","Select",""],["","72205000530","ROSUVASTATIN CALCIUM","40 MG","30","Select","Select",""],["","68645058459","METFORMIN HCL","1000 MG","60","Select","Select",""],["","53746051101","SPIRONOLACTONE","25 MG","15","Select","Select",""],["","68382056410","METOPROL SUC TAB","25MG ER","180","Select","Select",""],["","00003089421","ELIQUIS TAB","5MG","60","Select","Select",""],["","27241009903","DULOXETINE CAP","60MG","30","Select","Select",""],["","00310621030","FARXIGA TAB","10MG","30","Select","Select",""],["","00536589488","NICOTINE TD DIS","7MG\/24HR","7","Select","Select",""],["","16729022501","SPIRONOLACT TAB","25MG","15","Select","Select",""],["","70700015010","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","68645058459","METFORMIN TAB","1000MG","60","Select","Select",""],["","00078065920","ENTRESTO TAB","24-26MG","60","Select","Select",""],["","72205000530","ROSUVASTATIN TAB","40MG","90","Select","Select",""],["","00186077760","BRILINTA TAB","90MG","60","Select","Select",""],["","16714008210","HYDROXYZ HCL TAB","25MG","30","Select","Select",""],["","72888006130","AMIODARONE TAB","400MG","28","Select","Select",""],["","00006011231","JANUVIA TAB","50MG","30","Select","Select",""],["","43547040211","FUROSEMIDE TAB","40MG","30","Select","Select",""],["","68462015713","ONDANSETRON TAB","4MG ODT","12","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","100","Select","Select",""],["","49035019602","EQ NICOTINE DIS","7MG\/24HR","7","Select","Select",""],["","53885004401","ONE TOUCH KIT VERIO FL","","1","Select","Select",""],["","53885019401","ONETOUCH KIT VERIO FL","","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":""}]}]}