{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELISSA COSTA","gend":1,"add":"5122 WOODBURY ST","city":"ROANOKE","state":"VA","zip":"24012-9998","dob":"1967-04-04","age":"","mstatus":"","insh":"20074945*01","cliId":"","pno":7578319850,"cno":7578319850,"email":"","ename":"","eno":"","pphy":"KIDD, JOSEPH H DO","ppno":5404279200,"pcpadd":"2145 MT PLEASANT BLVD,","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":"24014-9998","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":5404273237,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M47.812","J44.9","J30.2","M79.7","I49.9","R01.1","F41.8","Z87.891","Z77.22","Z86.16","Z87.01","M54.16","Z86.79","M54.12","R00.2","R06.02","R06.83","M50.30","M48.02","R79.89","NO DATA","Z79.51","Z79.899","R10.9","R07.89","R11.2","R50.9","F17.210","J84.10","M94.0","F41.9","U07.1","J18.9","R05.9","J40.","J96.21","J44.1","M50.10","M51.16","G89.29","M47.26","F32.9","Z80.1","Z80.41","Z83.49","Z82.0","Z82.5","M54.9","Z20.822","J96.01","R07.9","Z01.812","J45.50","F17.201","I47.1","R05.3","G47.00","N20.0","M25.551","R00.0","J45.909","Z23.","J30.9","L82.1","Z71.3","K21.9","R94.31","J45.21","Z91.09","Z12.2","J01.10","N12.","R51.9","J01.80","J45.901","E87.6","F17.290","K52.9","M54.2","Z72.0","R10.31"],"date":["2022-10-05","2022-12-28","2022-12-28","2023-03-28","2022-12-28","2022-12-28","2023-03-28","2022-12-28","2022-12-28","2022-12-28","2022-12-28","2021-12-16","2021-08-17","2023-02-21","2021-08-17","2021-08-17","2021-08-17","2021-11-05","2022-03-04","2022-03-04","2023-06-06","2022-07-25","2022-11-21","2022-07-25","2022-07-25","2023-06-06","2022-07-25","2022-11-21","2022-08-10","2022-08-10","2022-08-10","2022-11-28","2022-11-28","2022-11-28","2022-11-21","2022-11-24","2022-11-24","2023-01-10","2021-06-25","2023-06-06","2021-08-17","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2023-06-06","2022-10-15","2022-11-21","2022-11-21","2021-08-25","2022-04-19","2022-04-19","2022-11-21","2022-10-11","2022-04-19","2022-07-25","2022-07-25","2022-07-25","2022-09-06","2022-09-06","2023-03-28","2022-09-06","2022-10-12","2022-10-12","2021-07-13","2021-11-18","2021-11-18","2021-11-18","2022-01-19","2022-07-25","2023-01-27","2022-10-15","2022-11-21","2022-11-21","2022-11-21","2022-11-21","2023-01-10","2022-10-11","2023-06-06"],"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":[["","00173069700","ADVAIR DISKU","AER 500\/50","60","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","180","Select","Select",""],["","70436001006","BUPROPN HCL","TAB 150MG XL","10","Select","Select",""],["","66993058697","FLUTIC\/SALME","AER 500\/50","60","Select","Select",""],["","00173088210","BREO ELLIPTA","INH 200-25","60","Select","Select",""],["","60219170701","PREDNISONE","TAB 10MG","30","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","69452017213","AZITHROMYCIN","TAB 500MG","5","Select","Select",""],["","70710122701","AMITRIPTYLIN","TAB 50MG","90","Select","Select",""],["","31722072610","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","65162019011","NAPROXEN","500 MG","20","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","14","Select","Select",""],["","72578005518","DOXYCYCL HYC","CAP 100MG","14","Select","Select",""],["","68462015813","ONDANSETRON","TAB 8MG ODT","20","Select","Select",""],["","70436015542","PROMETHAZINE","SOL DM","120","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER","18 MCG","30","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","27241009903","DULOXETINE HCL","60 MG","180","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","00173069700","ADVAIR DISKUS","500-50 MCG","60","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","66993058697","FLUTICASONE-SALMETEROL","500-50 MCG","180","Select","Select",""],["","70010016305","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","00115180301","HYDROXYZINE PAMOATE","25 MG","30","Select","Select",""],["","43547028111","ESCITALOPRAM OXALATE","10 MG","60","Select","Select",""],["","29300042010","AMITRIPTYLINE HCL","25 MG","30","Select","Select",""],["","00591352530","LIDOCAINE","5 %","20","Select","Select",""],["","55111018015","TIZANIDINE HCL","4 MG","20","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","00781185220","AMOX\/K CLAV TAB","875-125","14","Select","Select",""],["","70710122601","AMITRIPTYLIN TAB","25MG","30","Select","Select",""],["","66993058697","FLUTIC\/SALME AER","500\/50","60","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","16571040250","CETIRIZINE TAB","10MG","30","Select","Select",""],["","51991074890","DULOXETINE CAP","60MG","60","Select","Select",""],["","31722072610","MONTELUKAST TAB","10MG","90","Select","Select",""],["","70010075401","METHOCARBAM TAB","500MG","90","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","30","Select","Select",""],["","69097052444","DICLOFENAC GEL","1%","100","Select","Select",""],["","00173069700","ADVAIR DISKU AER","500\/50","60","Select","Select",""],["","68462019001","NAPROXEN TAB","500MG","30","Select","Select",""],["","67877054360","CEFDINIR CAP","300MG","10","Select","Select",""],["","68462015813","ONDANSETRON TAB","8MG ODT","20","Select","Select",""],["","60219170701","PREDNISONE TAB","10MG","30","Select","Select",""],["","69452017213","AZITHROMYCIN TAB","500MG","5","Select","Select",""],["","72578005518","DOXYCYCL HYC CAP","100MG","14","Select","Select",""],["","00069108530","PAXLOVID TAB","300-100","30","Select","Select",""],["","55111015810","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","42806071401","BENZONATATE CAP","100MG","30","Select","Select",""],["","70436015542","PROMETHAZINE SOL DM","","120","Select","Select",""],["","00005200010","PREVNAR","20 0.5 ML","0.5","Select","Select",""],["","64764073030","TRINTELLIX","10 MG","30","Select","Select",""],["","68180096412","TIOTROPIUM BROMIDE","18 MCG","90","Select","Select",""],["","58160082311","SHINGRIX","50 MCG\/0.5","1","Select","Select",""],["","49281072310","FLUBLOK QUAD","2023-2024 180MCG\/0.5","0.5","Select","Select",""],["","49035045875","ALLERGY RELIEF","10 MG","90","Select","Select",""],["","00093005301","BUSPIRONE HCL","5 MG","60","Select","Select",""],["","29300041519","CYCLOBENZAPRINE HCL","10 MG","90","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":""}]}]}