{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON F WELCHER","gend":1,"add":"354 BRIGGS RD LOT 109","city":"SHAWSVILLE","state":"VA","zip":"24162-9998","dob":"1966-05-07","age":"","mstatus":"","insh":"20082898*01","cliId":"","pno":5406982520,"cno":5406982520,"email":"","ename":"","eno":"","pphy":"KINSEY, ADRIENNE M DO","ppno":5403870441,"pcpadd":"1935 W MAIN ST,","pcpcity":"SALEM","pcpstate":"VA","pcpzip":"24153-9998","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":5403897868,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.2","J43.9","K74.69","F17.200","R05.3","F31.32","F29.","F10.10","M79.671","M25.571","G89.4","Z79.891","Z51.81","G57.71","E11.65","E03.9","S93.491A","NO DATA","R20.2","R20.0","E11.9","E07.9","K21.9","Z79.84","Z79.890","J44.9","R09.02","R91.1","F17.210","Z72.0","M54.6","M54.16","M47.817","M47.816","M53.3","M47.814","E11.22","Z23.","E11.69","M21.969","M54.12","B35.1","M79.675","M79.674","R05.1","R16.1","K76.6","R18.8","K57.30","J06.9","K74.60","K22.70","K31.84","K59.04","J34.89","F33.2","M25.671","M62.81","G89.29","L73.9","E83.119","S63.502A","M25.462","M25.812","M25.852","M25.362","W19.XXXA","M19.071","R06.02","H66.013","R41.0","R51.9","E87.6","R41.82"],"date":["2023-05-15","2023-07-26","2022-05-13","2023-07-26","2022-05-13","2022-10-12","2022-10-12","2022-10-12","2022-07-25","2023-06-13","2023-03-10","2023-08-29","2023-08-29","2023-06-28","2022-08-09","2023-06-23","2022-08-09","2023-05-11","2023-05-11","2023-05-11","2023-07-26","2023-07-26","2023-07-26","2023-07-26","2023-07-26","2023-05-15","2023-05-15","2023-05-15","2023-05-15","2022-09-29","2023-08-29","2022-11-15","2022-11-15","2022-11-15","2022-05-12","2022-06-06","2023-04-25","2023-04-25","2022-08-09","2022-08-09","2023-08-29","2023-04-11","2023-04-11","2023-04-11","2022-09-15","2022-05-13","2022-05-13","2022-05-20","2022-05-13","2022-12-12","2022-05-20","2022-05-20","2022-05-20","2022-05-20","2022-10-13","2023-08-09","2023-06-13","2023-06-13","2023-05-11","2023-06-23","2023-06-23","2023-07-08","2023-07-08","2023-07-08","2023-07-08","2023-07-19","2023-07-08","2023-04-25","2023-07-26","2023-07-24","2023-07-26","2023-07-26","2023-07-26","2023-07-26"],"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":[["","54092054701","MOTEGRITY","2 MG","30","Select","Select",""],["","00597015561","STIOLTO","AER 2.5-2.5","4","Select","Select",""],["","10702000310","PROMETHAZINE","TAB 25MG","15","Select","Select",""],["","69584068410","PRIMIDONE","TAB 50MG","90","Select","Select",""],["","29300013905","DIVALPROEX","TAB 250MG DR","90","Select","Select",""],["","42858049340","BUPRENORPHIN","DIS 10MCG\/HR","4","Select","Select",""],["","00113057139","ALLER-EASE","180 MG","30","Select","Select",""],["","53746010905","HYDROCO\/APAP","TAB 5-325MG","90","Select","Select",""],["","47781066210","LEVOTHYROXIN","TAB 150MCG","60","Select","Select",""],["","16729022716","SPIRONOLACT","TAB 100MG","30","Select","Select",""],["","51991070510","ALPRAZOLAM","TAB 0.5MG","90","Select","Select",""],["","00093506110","HYDROXYZ HCL","TAB 25MG","90","Select","Select",""],["","00597015330","JARDIANCE","25 MG","30","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","43547040211","FUROSEMIDE","40 MG","90","Select","Select",""],["","59011075104","BUTRANS","10 MCG\/HR","4","Select","Select",""],["","08290320119","BD PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","31722071310","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","51224002206","AZITHROMYCIN","250 MG","6","Select","Select",""],["","43598016530","OLANZAPINE","TAB 7.5MG","30","Select","Select",""],["","00172572970","FAMOTIDINE","40 MG","90","Select","Select",""],["","65862001705","AMOXICILLIN","500 MG","60","Select","Select",""],["","00185067405","HYDROXYZ PAM","CAP 25MG","90","Select","Select",""],["","64380078508","PREDNISONE","20 MG","8","Select","Select",""],["","27808023302","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","59310057922","PROAIR HFA","90 MCG","8.5","Select","Select",""],["","42858083940","BUPRENORPHINE","20 MCG\/HR","4","Select","Select",""],["","16729022716","SPIRONOLACTONE","100 MG","90","Select","Select",""],["","31722071310","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","16729013616","CLONAZEPAM","0.5 MG","60","Select","Select",""],["","00955172805","INSULIN GLARGINE SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","00597015561","STIOLTO RESPIMAT","2.5-2.5MCG","4","Select","Select",""],["","00406012301","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","90","Select","Select",""],["","16729045517","LEVOTHYROXINE SODIUM","150 MCG","60","Select","Select",""],["","45802091987","CETIRIZINE HCL","10 MG","90","Select","Select",""],["","29300013905","DIVALPROEX SODIUM","250 MG","90","Select","Select",""],["","42385094905","METFORMIN HCL","1000 MG","60","Select","Select",""],["","00536589588","NICOTINE PATCH","14MG\/24HR","28","Select","Select",""],["","31722071310","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","60432060416","PROMETHAZINE SYP DM","","120","Select","Select",""],["","47781066210","LEVOTHYROXIN TAB","150MCG","60","Select","Select",""],["","42858049340","BUPRENORPHIN DIS","10MCG\/HR","4","Select","Select",""],["","43598016530","OLANZAPINE TAB","7.5MG","30","Select","Select",""],["","00093506110","HYDROXYZ HCL TAB","25MG","90","Select","Select",""],["","00172572970","FAMOTIDINE TAB","40MG","30","Select","Select",""],["","29300013905","DIVALPROEX TAB","250MG DR","90","Select","Select",""],["","00597015561","STIOLTO AER","2.5-2.5","4","Select","Select",""],["","69315011710","FUROSEMIDE TAB","40MG","30","Select","Select",""],["","10702000310","PROMETHAZINE TAB","25MG","15","Select","Select",""],["","54092054701","MOTEGRITY TAB","2MG","30","Select","Select",""],["","59762219803","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","16729022716","SPIRONOLACT TAB","100MG","30","Select","Select",""],["","69584068410","PRIMIDONE TAB","50MG","90","Select","Select",""],["","00597015330","JARDIANCE TAB","25MG","30","Select","Select",""],["","31722099601","HYDROCO\/APAP TAB","5-325MG","90","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","08290320119","BD PEN NEEDL MIS","31GX5MM","100","Select","Select",""],["","51991070510","ALPRAZOLAM TAB","0.5MG","18","Select","Select",""],["","59011075104","BUTRANS DIS","10MCG\/HR","4","Select","Select",""],["","00115180302","HYDROXYZ PAM CAP","25MG","90","Select","Select",""],["","57237003105","AMOXICILLIN CAP","500MG","20","Select","Select",""],["","00113057139","ALLER-EASE TAB","180MG","30","Select","Select",""],["","27808023302","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","64380078408","PREDNISONE TAB","10MG","30","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","70436015542","PROMETHAZINE SOL DM","","120","Select","Select",""],["","65862001205","SERTRALINE HCL","50 MG","30","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","30","Select","Select",""],["","29300011101","LAMOTRIGINE","25 MG","60","Select","Select",""],["","27241009810","DULOXETINE HCL","30 MG","30","Select","Select",""],["","57237000905","MIRTAZAPINE","30 MG","30","Select","Select",""],["","70010077005","METHOCARBAMOL","750 MG","60","Select","Select",""],["","62756042790","CIPROFLOXACIN-DEXAMETHASONE","0.3 %-0.1%","7.5","Select","Select",""],["","00185067405","HYDROXYZINE PAMOATE","25 MG","90","Select","Select",""],["","00002143380","TRULICITY","0.75MG\/0.5","2","Select","Select",""],["","58160082311","SHINGRIX","50 MCG\/0.5","1","Select","Select",""],["","33332032303","AFLURIA QUAD","2023-24 (3YR UP) 60MCG\/.5ML","0.5","Select","Select",""],["","00054074287","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","67877049005","EZETIMIBE","10 MG","30","Select","Select",""],["","45802081184","NALOXONE HCL","4 MG","2","Select","Select",""],["","59385002260","BELBUCA","150 MCG","60","Select","Select",""],["","45802011222","MUPIROCIN","2 %","22","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":""}]}]}